Development of a robust, valid and reliable swallow screening tool for nurses to use with stroke patients

Swallowing difficulties (dysphagia) occur in 45% of acute stroke patients (DePippo 1994), causing aspiration pneumonia and malnutrition, significantly impairing rehabilitation. The intercollegiate working party for stroke guidelines 2004 state that the patient should have their ‘swallow assessed as soon as possible by a suitably trained specialist who should then advise the patient and staff on safe swallowing and consistency of diet and fluid’. Speech and language therapists (SALTs) are recognised as having the pre-requisite training and skills to assess and manage dysphagic individuals.

Despite nurses being recognised as having an important role in identifying patients at risk (RCSLT 1998, RCP 2000), there is diversity in role definition, where some will be solely screening patients and others will screen, assess and directly manage simple cases.

Project Leads

Professor Caroline Watkins
Elizabeth Boaden

Project Staff

Ben Vickerstaff , Royal Liverpool and Broadgreen University Hospitals NHS Trust
Irene McClelland, Royal Liverpool and Broadgreen University Hospitals NHS Trust

Collaborators

Dr Jim Anson
Dr Cathy Jack

Funders

Cheshire & Merseyside Workforce Development Confederation

Timeline

October 2003

Research

Specifically the following research questions will be explored in a programme of research:

• What drinks, food and consistencies are used in a swallow screening tool as part of current practise?
• Can a valid and reliable tool be devised that is a safe and effective swallow screening tool for nurses to use in stroke patients?

Research objective(s)

This research is to develop a valid and reliable swallow screening tool that assesses for diet and fluid allowing nurses to fulfil the requirements of the guidelines.

Method

Settings
Royal Liverpool and Broadgreen University Hospitals NHS Trust

Plan of Investigation

• What drinks, food and consistencies are used in a swallow screening tool as part of current practise?
  A review of current clinical practise will be implemented, the results considered and where appropriate incorporated into the study.
• A postal questionnaire will be disseminated in order to survey all Speech and Language Therapists (90) and nurses (200) from the North West Stroke Task Force Database, to establish which textures/fluids are currently recommended for use in swallow screening. Telephone interviews will be used to follow up non-respondents and to clarify any misinterpretation of questions.
• What are the relative risks associated with different drinks, food and consistencies?
  The safety of different fluids/textures will be formally tested in microbiology studies.
• Can a valid and reliable tool be devised that is a safe and effective swallow screening tool for nurses to use in stroke patients?

A dysphagia screening tool will be developed by identifying the safe texture/fluid from the microbiology results with the pre-existing standardised test for water i.e. thin fluid swallow screen.

The screening tool will be exposed to an expert panel of healthcare professionals working with dysphagia in order to establish face validity. The screening tool will also be discussed with SALTs and nurses using face to face interviews to establish reliable interpretation of the range of factors considered, scoring system and action required.

Validity and reliability (SALT and nurses) will then be explored in intra and inter rater reliability studies.