Nursing Interventions for Identifying and Managing Acute Dysphagia are Effective for Improving Patient Outcomes: A Systematic Review Update.

BACKGROUND: Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological impairment, largely from stroke. Dysphagia is not generally considered a major cause of mortality; however, the complications that result from this medical condition, namely, aspiration pneumonia and malnutrition, are among the most common causes of death in the older adults.

METHODS: This is an update of an existing systematic review. The standard systematic review methods of the Joanna Briggs Institute were used. Methods were specified in advance in a published protocol. A wide range of databases were searched for quantitative research articles examining the effectiveness of nursing interventions to identify and manage dysphagia in adult patients with acute neurological dysfunction, published between 2008 and 2013.

RESULTS: Four new studies were added in this update, for a total of 15 included studies. Strong evidence was found to show that nurse-initiated dysphagia screening is effective for reducing chest infections in patients with dysphagia (odds ratio [OR] = 0.45, 95% CI [0.33, 0.62], p < .00001). Nurse-initiated dysphagia screening by trained nurses may be effective for detection of dysphagia, and training nurses in dysphagia screening improves the number and accuracy of screens conducted. The presence of formal dysphagia guidelines in a health facility is likely to reduce inpatient deaths (OR = 0.60, 95% CI [0.43, 0.84], p = .003) and chest infections (OR = 0.68, 95% CI [0.51, 0.90], p = .008); however, it does not appear that formal guidelines have an effect on length of stay.

CONCLUSIONS: Nurse-initiated dysphagia screening for patients with acute neurological dysfunction is effective for a range of important patient outcomes. The presence of formal guidelines for the identification and management of dysphagia may have a significant effect on serious adverse outcomes such as chest infections and death. Training nurses to conduct dysphagia screening will improve patient outcomes.