title: Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit: A Clinical Audit.
abstract: OBJECTIVE
  In patients with acute stroke, undernutrition and aspiration pneumonia are associated with increased mortality and length of hospital stay. Formal screening for nutritional risk and dysphagia helps to ensure optimal nutritional management in all patients with stroke and to reduce the risk of aspiration in patients with dysphagia. We developed a national guideline for nutritional and dysphagia screening in acute stroke, which was introduced in our stroke unit on June 1, 2012. The primary objective was to audit adherence to the guideline and to achieve full implementation. Second, we assessed the prevalence of nutritional risk and dysphagia.
  
  
  METHODS
  We performed a chart review to assess performance of screening for nutritional risk and dysphagia in all patients with stroke hospitalized for ≥48 hours between June 1, 2012, and May 31, 2013. Next we applied a "clinical microsystems approach" with rapid improvement cycles and audits over a 6-month period to achieve full implementation.
  
  
  RESULTS
  The chart review showed that nutritional risk screening was performed in 65% and swallow testing in 91% of eligible patients (n = 185). Proactive implementation resulted in >95% patients screened (n = 79). The overall prevalence of nutritional risk was 29%, and 23% of the patients failed the initial swallow test.
  
  
  CONCLUSIONS
  Proactive implementation is required to obtain high screening rates for nutritional risk and swallowing difficulties using validated screening tools. The proportion of patients at nutritional risk and the prevalence of dysphagia at initial swallow test were in the lower range of previous reports.
authors.affiliation: Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Margitta T
authors.initials: MT
authors.lastname: Kampman
authors.affiliation: Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Agnethe
authors.initials: A
authors.lastname: Eltoft
authors.affiliation: Department of Neurology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Migle
authors.initials: M
authors.lastname: Karaliute
authors.affiliation: Department of Therapeutic Services, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Margrethe T
authors.initials: MT
authors.lastname: Børvik
authors.affiliation: Department of Clinical Nutrition, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Hugo
authors.initials: H
authors.lastname: Nilssen
authors.affiliation: Department of Clinical Nutrition, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Ida
authors.initials: I
authors.lastname: Rasmussen
authors.affiliation: Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Stein H
authors.initials: SH
authors.lastname: Johnsen
keywords: acute stroke; dysphagia; nutrition; quality improvement