Nurse-led dysphagia screening in the intensive care unit - An implementation study.

Background: Post-extubation is common in the intensive care unit and bedside screening by nurses is important to detect the condition and avoid aspiration to the airways.
Objective: To assess the implementation of nurse-led, systematic dysphagia screening in the intensive care unit and to identify barriers and facilitators for dysphagia screening.
Methods: Design: Pragmatic implementation study. Based on a programme theory, key behaviours were identified using the Behaviour Change Wheel framework. Implementation activities included education, e-learning, bedside peer support, feedback, and cues in the environment. Data sources included chart reviews, participant logs, implementation log and focus group interviews.
Results: Participant logs showed high participation in educational sessions, less in e-learning. Chart reviews showed very little use of nurse-led dysphagia screening. Focus groups showed that nurses accepted the Yale Swallow Protocol as valid, that new skills and understandings led to empowerment of nurses and aided decision making. Important barriers were keeping patients nil-per-mouth for intubation, lack of social support from other professionals and difficulties with documentation. Facilitators were social support from colleagues.
Conclusion: Implementation of nurse-led screening in intensive care was possible but challenged by external factors. Attention should be given to altercation of the screening protocol to avoid alteration of the instrument and easy documentation.
Implication for patient care: Implementation of nurse-led dysphagia screening in intensive care may facilitate safe oral intake in patients and identify patients in need of specialised assessment. Implementation should aim to provide nurses with competences in screening patients swallowing function and allow contextualisation without altering the properties of the instrument.