A Decision Guide for Assessing the Recently Extubated Patient’s Readiness for Safe Oral Intake

医学 吞咽困难 语言病理学 吞咽 医疗保健 梅德林 多学科方法 重症监护室 医疗急救 重症监护医学 物理疗法 外科 社会学 法学 经济 经济增长 社会科学 政治学
作者
Waverlyn J. Royals,Rita J. Gillis,Jarvis L. Campbell
出处
期刊:Critical Care Nurse [AACN Publishing]
卷期号:43 (1): 42-51 被引量:1
标识
DOI:10.4037/ccn2023722
摘要

Postextubation dysphagia is a known consequence of endotracheal intubation. Several risk factors for postextubation dysphagia have been identified that could be used to help determine which patients should undergo swallowing assessment by an appropriate professional.At the authors' institution, critical care nurses, health care providers, and speech-language pathology professionals lacked a clear process for referring patients for swallowing assessment after extubation, resulting in inefficiency and confusion. Information to guide their decision-making in this area was needed. To address this need, a multidisciplinary group convened and developed a guide with specific indicators.A review of the literature on postextubation dysphagia was conducted to determine the most appropriate indicators for the guide, which was piloted in the medical intensive care unit. The utilization rate was calculated. Referrals to speech-language pathology professionals were tabulated before and after the project.During the 11 months before implementation of the project, there were 994 speech-language pathology consultations for postextubation evaluation of swallowing. During the 11 months after implementation, there were 831 consultations, representing a 16.4% reduction. The decline in consultations resulted in cost savings in addition to preventing unnecessary testing before patients' resumption of oral intake. The utilization rate for the guide during the project was 58%.The decision guide was an effective tool to help nurses and health care providers determine which patients should be referred to speech-language pathology professionals for swallowing assessment after extubation, facilitating the appropriate use of limited health care resources.
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