Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-2-2019

Graduate Advisor

Dr. Nancy Magnuson, DSN, APRN, FNP-BC

Committee

Dr. Laura Kuensting, DNP, APRN, PCNS-BC, CPNP, CPEN

Dr. Jessica Dickman, DNP, APRN, FNP-C, SCRN

Abstract

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen and/or the Burke three-ounce water test was assessed. In addition, the type of diagnosis and rate of HAP was evaluated for those patients who were admitted to the hospital and compared to the HAP rates during the same time period a year prior.

Results There were 621 patients (N=621) who had a CT performed in the ED. Of those, 95.3% (n = 591) received dysphagia screening. The presenting diagnoses were AMS (74.9%, n=465), stroke (38%, n=81), trauma (10%, n=64), tumor (2%, n=9), syncope (0.1%%, n=1), and seizure (0.1%, n=1). The hospital rate of HAP was 12.6% in 2018 and 9.9% in 2019. A decrease in HAP was 2.7% (t =-2.561, p < 0.01) over the two-months when the dysphagia screen was implemented for all patients.

Implications For Practice Performing a dysphagia screen prior to oral intake in patients who receive a head CT in the ED may reduce inpatient HAP rates.

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