Does the implementation of an e-learning package to medical and nursing staff improve adherence to dysphagia screening?

Miss Nicole Reyes1, Ms Lillian Krikheli1,2

1Cabrini Health, Malvern, Australia, 2La Trobe University, Bundoora, 3086

Abstract: 

Aim: To implement an e-learning package to medical and nursing staff to improve adherence to dysphagia screening using an acute swallow screening tool within 4 hours of diagnosis.

Method: Speech pathologists developed a dysphagia screening e-learning package, which included a competency assessment by the speech pathologist. Nursing and medical staff from the stroke unit and emergency department were invited to participate. Following successful completion, staff were instructed to implement ASSIST. Data was collected at three time-points via the patient administration system and medical record audit to review adherence to screening, time to screening, accuracy of completion, rate of aspiration-related pneumonia.

Result: 18 doctors and 27 nurses were invited for training; 9 achieved competency. For baseline, immediately and 12 months post-training, the respective findings were 0%, 8%, 53% for adherence to screening; N/A, 5.6 hours, 4.3 hours between diagnosis to screening; 0%, 28%, 47% for accuracy of completion; 0%, 14%, 0% for rate of aspiration-related pneumonia with screening; and 2%, 3%, 0% without screening.

Significance of findings to allied health: Dysphagia is present in 65% of stroke patients. Clinical practice guidelines recommend screening for dysphagia within 4 hours of diagnosis, with a Victorian screening benchmark of 67%. Implementation of an e-learning package did improve adherence to dysphagia screening over time and time taken to complete screening was encouraging, however it fell below the national benchmark and concerns remain over completion correctness.

Biography: 

Nicole Reyes (MA[Comms], USA) is a Speech Pathologist at Cabrini Health working in the acute setting. She has a keen interest in the management of neurological patients and is the primary speech pathologist for the stroke service. Nicole also supervises postgraduate speech pathology students as they enter the workforce. In addition to being a practising member of Speech Pathology Australia, she continues to hold her certificate of clinical competency from the American Speech-Language and Hearing Association.

Lillian Krikheli (BHSc, MSpPath) is a Speech Pathologist at Cabrini Health working in outpatient rehabilitation (progressive neuro, stroke and voice) plus inpatient and community palliative care. She is also a PhD candidate at La Trobe University, where she has taken an active academic role, bridging her passion for clinical speech pathology work with teaching within the School of Psychology and Public Health. Her doctoral research is an international modified Delphi study investigating the role and practice of speech pathologists working in paediatric palliative care settings.