Our nursing service has initiated a house wide screen and protocol for the prevention of aspiration pneumonia.  Our HAP reduction efforts are driven by two specific organizational objectives:  improving patient safety and organizational quality and efficiency.  For the purposes of this presentation we would like to describe our bedside dysphagia screening process and prevention protocol as an important step in this overall initiative.  

Clinical Relevance and Current Knowledge:     

Hospital-acquired pneumonia (HAP) is a major cause of morbidity and mortality in U.S. Hospitals.  HAP is second only to urinary tract infections as the most common nosocomial infection (NNIS, 2005).  Mortality associated with HAP runs upward to about 30% (20-70%).  Most patients with HAP are elderly, have underlying disease, and are immno-suppressed.  Patients on mechanical ventilators are at the greatest risk for developing HAP.  Outside the intensive care unit, those patients who have undergone surgical procedures are also at significant risk for the development of HAP. The direct and indirect costs associated with each episode of HAP, especially if they have been mechanically ventilated approximates $40,000/case.  The key cause of HAP is aspiration, both on and off the mechanical ventilator. 

Presentation Summary: 

The Dysphagia Screen was developed based on evidence in the nursing and medical literature.  The nine-point standardized risk factor scale is performed by nursing on each patient admitted to our medical center.  This screen is built into our automated documentation system and is performed on all patients admitted to our in-patient settings.  Once patients are identified at risk for aspiration, they are placed on aspiration precautions and reassessed every 12 hours until they no longer meet risk criteria.  The automated care plan will also be displayed showing how assessment data drives the care plan and precaution techniques.  We will also present our baseline HAP data, the results of the pilot program, and feedback from professional nurses on the ease, accuracy and efficiency of this screen.  

Implications for Practice:

Nurses are in a strategic position to be the first line screeners for patients who present with dysphagia.  Once aspiration risk is detected, a more formal evaluation may occur and preventive strategies implemented to reduce the over all incidence of HAP.  We are optimistic that not only will this detection and prevention program be key in reducing HAP at WMC; it will also reduce our overall hospital costs, and create a shift in culture awareness related to aspiration and its relationship to patient safety.