title: Factors precipitating the risk of aspiration in hospitalized patients: findings from a multicentre critical incident technique study.
abstract: OBJECTIVE
  To elucidate factors, other than those clinical, precipitating the risk of aspiration in hospitalized patients.
  
  
  METHODS
  The Critical Incident Technique was adopted for this study in 2015.
  
  
  METHODS
  Three departments located in two academic hospitals in the northeast of Italy, equipped with 800 and 1500 beds, respectively.
  
  
  METHODS
  A purposeful sample of 12 registered nurses (RN), all of whom (i) had reported one or more episodes of aspiration during the longitudinal survey, (ii) had worked ≥3 years in the department, and (iii) were willing to participate, were included.
  
  
  METHODS
  Antecedent factors involved in episodes of aspiration as experienced by RNs were collected through an open-ended interview, and qualitatively analysed.
  
  
  RESULTS
  In addition to clinical factors, other factors interacting with each other may precipitate the risk of aspiration episodes during hospitalization: at the nursing care level (misclassifying patients, transferring tasks to other healthcare professionals and standardizing processes to remove potential threats); at the family level (misclassifying patients, dealing with the cultural relevance of eating) and at the environmental level (positioning the patient, managing time pressures, distracting patient while eating, dealing with food consistency and irritating oral medication).
  
  
  CONCLUSIONS
  At the hospital level, an adequate nursing workforce and models of care delivery, as well as time for initial and continuing patient and family assessment are required. At the unit level, patient-centred models of care aimed at reducing care standardization are also recommended; in addition, nursing, family and environmental factors should be recorded in the incident reports documenting episodes of aspiration.
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Lesa
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Stroppolo
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Lupieri
authors.affiliation: Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tardivo
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Brusaferro
mesh_terms: D004435:Eating; D005190:Family; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007558:Italy; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D009726:Nurses; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010347:Patient Care Planning; D036301:Qualitative Research; D053120:Respiratory Aspiration / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Critical Incident Technique; Italy; antecedents; aspiration; clinical nurses; factors; medical units; prevention; qualitative study