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Preventing Aspiration Complications

Implementing a Swallow Screening Tool

Wangen, Tina MS, APRN, RN; Hatlevig, Janelle MA, OTR/L, BCPR; Pifer, Gina EdD, OTR/L, BCPR; Vitale, Kirsten MSN, RN

doi: 10.1097/NUR.0000000000000471
Feature Article

Aims: The aim of this study was to decrease the number of patients with acquired aspiration mortality.

Design: This was an evaluation research study. Data were collected on acutely ill hospitalized patients from January 2013 to December 2017.

Methods: In 2016, a 1100-bed Midwestern quaternary care facility found an increasing trend in mortality rates of patients with acquired aspiration from 2013 to 2015. A need for improved detection of patients at risk of aspiration was identified. A multidisciplinary team analyzed this need and developed a screening process found on the American College of Chest Physicians practice guidelines and the Massey Bedside Swallowing Screen to reduce these rates. Nurses implemented the aspiration risk screening process on all hospitalized patients. Data were collected through nursing responses and chart reviews.

Results: Initial implementation of the aspiration risk screening process yielded procedural concerns that were ameliorated through increased education and refinement of the screen. After refinement and reimplementation, mortality data from 2016 to 2017 revealed a decrease to zero aspiration-related events.

Conclusion: Our findings suggest implementation of a nursing-led aspiration risk screening process with acutely ill patients is a factor in decreasing patient mortality from acquired aspiration. These clinical practice changes of identifying patients at risk of aspirating and involving dysphagia therapists prior to oral intake increase patient safety while decreasing acquired aspiration mortality.

Impact: This study addressed upward trends in patient mortality with acquired aspiration. Mortality rates declined after implementation of the aspiration risk screening process on hospitalized patients. These findings have potential to impact healthcare personnel and all acutely ill hospitalized patients.

Author Affiliations: Nurse Manager (Ms Wangen), Occupational Therapist (Ms Hatlevig), and Informatics Nurse Specialist (Ms Vitale), Mayo Clinic Minnesota, Rochester; and Assistant Clinical Professor (Dr Pifer), University of Missouri-Columbia School of Health Professions.

The authors report no conflicts of interest.

Correspondence: Tina Wangen, MS, APRN, RN, Cardiovascular Diseases, Mayo Clinic Minnesota, 200 1st St SW, Rochester, MN 55905 (

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