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Nursing Swallow Screens: Why Is Testing Water Only Not Enough?

Ellis, Allison Loftiss; Hannibal, Ruth Renee

Journal of Neuroscience Nursing: October 2013 - Volume 45 - Issue 5 - p 244–253
doi: 10.1097/JNN.0b013e31829d8b5b
Article

The speech-language pathologist (SLP) standardized a Nursing Bedside Swallowing Screen (NBSS) tool for all patients admitted to the hospital. The adults engaged in the NBSS before oral intake (i.e., medication included) as part of the Brain Attack Pathway for patients with neurological symptoms. If the patient failed the NBSS in the emergency department (ED), then the screen was repeated again after the patient had been admitted before the SLP dysphagia evaluation. Fifty-three male and female patients ranging from 34 to 96 years old with an initial diagnosis of stroke or transient ischemic attack (TIA) admitted during an 8-week time period from April 25, 2010, to June 19, 2010, were included in this study. There were 32 women and 17 men including 27 strokes and 22 TIAs tested. As a whole, the NBSS and SLP dysphagia evaluation results were consistent with each other for 40 of 46 patients (86.96% perfect agreement). The NBSS had 74% of sensitivity (34 of 46) with the nursing and the speech pathologist in agreement with the patients passing the swallow screen. Accurate identification of aspiration with the patients failing the NBSS was evident with the nursing and speech pathology assessment, which resulted in 83% of sensitivity (10 of 12). The positive predictive value with the corresponding identification of aspiration with the staff was 96% (44 of 46). The naturalistic observation of the patients exhibited internal consistency reliability between the two disciplines. Extraneous variables affecting the results included spontaneous resolution of stroke or TIA symptoms or the patient’s decline in neurological status.

Video Abstract: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/JNN/A9.

Supplemental Digital Content is available in the text

Questions or comments about this article may be directed to Allison Loftiss Ellis, MSEd CCC-SLP, at Allisonellis03@gmail.com. She is a Speech-Language Pathologist at United Home Care of Greensboro, Greensboro, GA.

Ruth Renee Hannibal, PhD CCC-SLP, is an Associate Professor at the Department of Communication Sciences and Disorders, Valdosta State University, Valdosta, GA.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jnnonline.com).

© 2013 American Association of Neuroscience Nurses