title: Nursing swallow screens: why is testing water only not enough?
abstract: 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.
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authors.affiliation: 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.
authors.forename: Allison Loftiss
authors.initials: AL
authors.lastname: Ellis
authors.forename: Ruth Renee
authors.initials: RR
authors.lastname: Hannibal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000451:nursing*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000451:nursing; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D013041:Specialties, Nursing / Q000379:methods* / Q000592:standards*; D013066:Speech-Language Pathology / Q000379:methods / Q000592:standards; D020521:Stroke / Q000150:complications / Q000451:nursing; D014867:Water
chemical_list: D014867:Water