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Show Improving Adherence to Dysphagia Screening in Acute Stroke Patients by Registered Nurses BACKGROUND Stroke is a leading cause of disability in the U.S. Dysphagia increases pneumonia and mortality risk Local compliance: 56% (Goal: ≥85%) Screening is required before oral intake Evidence supports EHR prompts + education + leadership` METHODS Framework: Ko#er’s 8-Step Change Model 4 Design: Quality Improvement Project Se1ng: Primary Stroke Center (ED, ICU, IMC) Deliverables Created • RN Education PowerPoint • Unit-based Dysphagia Flyer • Pre/Post Microsoft Forms Survey • EHR Clinical Decision Support Prompt Implementation Steps • Present compliance data to create urgency • Form an interdisciplinary coalition • Build EHR dysphagia alert • Deliver RN education • Deploy unit-based reinforcement tools • Monitor compliance via GWTG-Stroke data REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. Faith Allen, BSN, RN, MSN Student Amber Fowler, DNP, MSN-Ed, RN April Briggs-James, APRN, FNP-C, BSN, RN, CPHQ INTERVENTIONS Post-stroke dysphagia significantly increases the risk of aspiration pneumonia, mortality, and prolonged hospitalization1. National stroke guidelines require dysphagia screening prior to oral intake and show that early dysphagia screening improves patient outcomes²; however, local data revealed compliance rates below the 85% benchmark. In Q1 2025, compliance was 56%, identifying a critical patient safety gap. Evidence supports education, EHR clinical decision support prompts, and leadership engagement as effective strategies to improve adherence3. This quality improvement project aims to increase RN compliance within three months of implementation. • • • • • A Quality Improvement Initiative Donovan, N. J., Daniels, S. K., Edmiaston, J., Weinhardt, J., Summers, D., & Mitchell, P. H. (2013). Dysphagia screening: State of the art. Stroke, 44(4), e24–e31. https://doi.org/10.1161/STR.0b013e3182877f57 Sherman, V., Greco, E., & Martino, R. (2021). The benefit of dysphagia screening in adult patients with stroke: A meta-analysis. Journal of the American Heart Association, 10(12), e018753. https://doi.org/10.1161/JAHA.120.018753 Lakshminarayan, K., Rostambeigi, N., Fuller, C. C., Peacock, J. M., & Tsai, A. W. (2012). Impact of an electronic medical record–based clinical decision support tool for dysphagia screening on care quality. Stroke, 43(12), 3399–3401. https://doi.org/10.1161/STROKEAHA.112.662536 Kotter, J. P. (1996). Leading change. Harvard Business School Press. Bray, B. D., Smith, C. J., Cloud, G. C., Enderby, P., James, M., Paley, L., Tyrrell, P. J., Wolfe, C. D. A., & Rudd, A. G. (2017). The association between delays in screening for and assessing dysphagia after acute stroke and the risk of stroke-associated pneumonia. Journal of Neurology, Neurosurgery & Psychiatry, 88(1), 25–30. https://doi.org/10.1136/jnnp-2016-313356 American Stroke Association. (n.d.). [Image depicting healthy swallowing and dysphagia]. American Stroke Association. https://www.stroke.org/en/about-stroke Nutricia. (n.d.). [Image illustrating a patient swallowing water]. Nutricia. https://www.nutricia.com Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer. • Step 1: Implement an EHR prompt requiring screening before oral intake 5 • Step 2: Deliver structured RN educa<on sessions to improve compliance and reduce complica<ons • Step 3: Distribute the visual reinforcement flyer • Step 4: Administer pre- and post-surveys • Step 5: Monitor compliance + provide leadership feedback IMPACTS Short-Term Impacts • Increased RN compliance • Improved knowledge and confidence • Improved documentation accuracy Long-Term Impacts • Reduced aspiration pneumonia • Improved stroke metrics • Sustained patient safety culture • Strengthened stroke program performance • Alignment with national benchmarks 6 CONCLUSIONS 7 Improving RN adherence to dysphagia screening is a critical patient safety priority in acute stroke care. Evidence supports combining education, EHR decision support, and leadership engagement to improve compliance. Embedding screening prompts into the nursing workflow reduces missed screenings and strengthens accountability8. Sustained adherence aligns bedside nursing practice with national stroke quality standards. This project advances evidence-based nursing practice and promotes safer stroke care delivery. |
