Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-10-2024

Graduate Advisor

Joshua Minks PhD, FNP-C

Committee

Joshua Minks PhD, FNP-C

Tonya Haynes DNP, RN

Pamela Hale David MSN, RN

Abstract

Abstract

Problem: Post extubation dysphagia (PED) increases the patient’s risk for long term complications contributing to increased healthcare cost. Intensive care settings rarely use standardized swallow screening assessments for patients post extubation leading to variation in the evaluation of PED. Variation in the assessment of swallowing post extubation can lead to the missed diagnosis of patients with dysphagia.

Methods: This quality improvement (QI) project was a prospective cohort study implementing an evidence-based swallow screening protocol, the Yale Swallow Protocol (YSP), in an intensive care unit. This study was conducted over four months, which included a pre survey, education, implementation, and post survey. Qualitative and quantitative data was collected from the electronic medical record on the patient responses to the screening. The surveys were distributed via QR code on a flyer and recorded in an Excel sheet via Google Forms.

Results: The total number of YSP screenings was 24 (11 passed (46%), 9 failed (37%), and 4 (17%) were excluded). Seven (78%) of the failed screenings were validated with a fiberoptic endoscopic evaluation of swallowing test (FEES) or modified barium swallow study (MBS) showing mild to moderate dysphagia (n=5, 72%), aspiration (n=1, 14%), and laryngeal edema (n=1, 14%).

Implications for Practice: The YSP provides clinical settings with a swallow screen that identifies extubated patients with an increased risk for dysphagia.

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