Appalachian Stroke Network Dysphagia Screening Update Ruby Memorial Hospital Primary Stroke Center Morgantown, WV Bruce McKee MS,CCC/SLP Director, Rehabilitation Services 304-598-4118

Ruby Memorial Hospital Primary Stroke Center Current acute beds: 531 Dedicated Neuro beds 14 floor beds 12 step-down beds 8 Neuro ICU beds Overflow to other units 2015: 978 Stroke Page Activations (81.5/mos) January 2017 acute beds: 575

Nursing Standardized Swallow Assessment Dysphagia screening for acute stroke and TIA patients that was published by Perry in 2001. It is currently administered by RN’s who have completed a hands-on training course conducted by a Speech Pathologist. There are two sections of the SSA. Part A involves observing the patient (is patient alert and responsive to speech, maintain an upright posture, follow oral motor commands, cough on command, breath freely, clear vocal quality). Not observed=FAIL Part B involves presentation of water. RN observes for s/s aspiration. Cough, throat clear or wet vocal quality=FAIL FAIL=Patient NPO, await S&S evaluation. PASS=patient started on baseline diet. Will still be evaluated by S&S.

Our Performance JC Benchmark: 85.7% 2014: 74.5% 2015: 79.5%

Challenges Oral meds charted on intubated patients Off-service/off-unit patients Oral meds documented prior to screening Hemorrhagic strokes, non-traumatic brain bleeds Terminology Swallow Screening vs Speech & Swallow Evaluation

Strategies for Improvement Dysphagia Sub-committee Spotlight performance Daily audits/emails Monthly PI meetings Personal feedback Emails and counseling to staff Real-time communication Reminders Ongoing Education House-wide Nursing Aspiration Screening Tool