护士主导的针对有吞咽困难风险的老年患者的言语治疗师转诊倡议:一个最佳实践实施项目。

IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Jbi Evidence Implementation Pub Date : 2023-12-01 DOI:10.1097/XEB.0000000000000384
Adeline Nyong Siew Khor, Westine Wei Lin Juay, Yi Yan Wong, Nur Elydia Binte Omar, Yajing Liu, Yingying Kong, Mien Li Goh
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引用次数: 0

摘要

引言和目的:吞咽困难在老年患者中很常见,影响他们的营养状况、再次入院、住院时间和住院费用。护士可以通过系统筛查在早期识别吞咽困难方面发挥关键作用。该项目旨在(i)护士对患者使用4点问卷测试(4QT)吞咽筛查测试的依从性达到80%,以及(ii)确保所有吞咽困难筛查呈阳性的患者在1天内转诊至言语治疗师。方法:一组言语治疗师、一名老年病学家和一名受过老年医学培训的护士根据循证筛查工具4QT改编了一种短咽筛查工具。然后,病房护士接受了使用该工具在入院或转移到另一个病房时对老年患者进行筛查的培训。该项目使用了JBI证据实施框架,其中包括事前和事后审计和反馈,以评估对最佳做法的遵守情况。结果:短咽筛查工具的依从性从64%(n = 25)增加到71%(n = 34)在后续审计中。然而,将吞咽困难筛查呈阳性的患者转诊给言语治疗师的人数有所减少,转诊率从92%(n = 12) 至86%(n = 12) 。所有患者(n = 12) 在基线和随访审计中,在入院/转院后1天内转诊给言语治疗师,而70%(n = 7) 结论:该项目将循证建议应用于临床实践,改善了患者的预后。护士们为及时转诊给言语治疗师进行进一步评估和干预提供了便利,这在临床上很有用。护士们继续常规使用筛查工具来预防老年患者的吞咽困难并发症。
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Nurse-led speech therapist referral initiative for older adult patients at risk of dysphagia: a best practice implementation project.

Introduction and objectives: Dysphagia is common among older patients, affecting their nutritional status, hospital readmission, length of hospital stay, and hospitalization costs. Nurses can play a key role in early identification of dysphagia through systematic screening. This project sought to (i) achieve 80% compliance among nurses in using the 4-point questionnaire test (4QT) swallow screening test on patients and (ii) ensure all patients screening positive for dysphagia were referred to a speech therapist within 1 day.

Methods: A short swallow screening tool was adapted from an evidence-based screening tool, the 4QT, by a team of speech therapists, a geriatrician, and a geriatric trained nurse. Ward nurses were then trained on using the tool to screen older patients upon admission or transfer to another ward. The project used the JBI Evidence Implementation Framework, which involved pre and post audits and feedback to evaluate compliance with best practice.

Results: Compliance increased in the use of the short swallow screening tool, rising from 64% ( n  = 25) in the baseline audit to 71% ( n  = 34) in the follow-up audit. However, there was a decrease in the referral of patients who screened positive for dysphagia to speech therapists, with the rate dropping from 92% ( n  = 12) to 86% ( n  = 12). All patients ( n  = 12) from both baseline and follow-up audits were referred to a speech therapist within 1 day of admission/transfer post-implementation compared with 70% ( n  = 7) at pre-implementation.

Conclusions: This project applied evidence-based recommendations to clinical practice and improved patient outcomes. The nurses facilitated timely referrals to speech therapists for further assessment and intervention, which was useful in the clinical context. The nurses continue to use the screening tool routinely to prevent dysphagia complications among geriatric patients.

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CiteScore
3.20
自引率
13.00%
发文量
23
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