1. 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

2. ED Triage / Chief Complaint- CCMC

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

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

6. 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%

7. Initial Contact Letter

8. Survey Form

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

10. 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?