Process Flow Map - CCMC Nurse Physician Identification of signs and symptoms of stroke Nurse Maintain NPO status Physician Complete Urgent Stroke Care per Protocol Dysphagia Screen Completed in the ED No No Dysphagia Screen completed in ED Yes Patient Admitted? No Patient Demonstrates a Safe Swallow? Yes Maintain NPO Status Dysphagia Screen is completed at time of Admission by floor nurse Transfer patient to another facility Yes No Patient Demonstrates a Safe Swallow? No Consult physician for PO orders Maintain NPO and consult Speech Therapy for Dysphagia Evaluation Yes Was a stroke order set used? No Maintain NPO and consult Speech Therapy for Dysphagia Evaluation Yes Activate “diet as tolerated” Order Consult physician for PO orders

ED Triage / Chief Complaint- CCMC

Dysphagia Screen Tool - CCMC *DepippoK, HolasM, RedingM: Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol.1992;49:1259-1261

Our Progress - CCMC GAP: Baseline = 48.5% Target= 85% Current= 87%

Performance Measurement & Improvement Committee ASN meeting - November, 2015 Performance Measurement & Improvement Committee Established Rhonda Boso-Suggs – WVU Medicine - CCMC Janine Hiles – WVU Medicine - CCMC Angela Schaffer – WVU Medicine – Ruby After discussion, the decision was made to look at the Dysphagia Screening Process in the Stroke Population Region Wide. Survey Form was developed to collect baseline data. Initial Contact Letters and Survey Form were mailed to Regional Hospitals on 1/15/16. Two follow-up electronic mailings of the letter and survey form occurred over the next month. 65 Facilities received the Survey 8 Facilities returned the Survey = Response rate of 12%

Initial Contact Letter

Survey Form

Data 99% 95% 100% 87% 83% 82%

Points of Discussion Disappointing Response rate. Certification appears to have a positive impact on compliance with the standard of care around dysphagia screening in the Stroke Population. Where do we go from here?