American Association of Neuroscience Nurses, Society of Pediatric Nurses & American Pediatric Surgical Nurses Association, Inc.

View all recommendations from this society

December 1, 2022

Don’t order “formal” swallow evaluation in stroke patients unless they fail their initial swallow screen.

Dysphagia (difficulty swallowing) is a common disorder in patients who have suffered a stroke, occurring in 50–60% of acute stroke patients. It is associated with an increased risk of aspiration, pneumonia, prolonged hospital stay, disability, and death. Swallow screening is critical in the rapid identification of risk of aspiration in patients presenting with acute stroke symptoms. Because formal swallowing evaluation is not warranted in all patients with acute stroke, the purpose of a swallowing screen is to identify those who do not need a formal evaluation and who can safely take food and medication by mouth. Formal swallowing evaluations can be done in patients who don’t pass the initial screening.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

(1–5 & 8) Members of the American Association of Neuroscience Nurses formed a task force to review evidence and make a recommendation of 5–10 things nurses should tell neuroscience patients to consider. AANN’s Special Focus Groups, which are composed of subject matter experts in various subspecialties of neuroscience, were consulted to help identify topics and provide supporting evidence. The task force reviewed the items for possible inclusion to determine the top recommendations. The top recommendations were presented to the AANN Board for review and approval.

(6) SPN initially reached out to several subject matter experts to learn about topic areas where they were aware of both evidence of overuse of health care resources and evidence-based resources to support addressing that overuse. SPN then chose two experts with research experience within the topic area we identified. One served as the main author while the other served as the reviewer. After the initial review was completed, we shared the content with the SPN Board of Directors for further input. Finally, colleagues at the American Academy of Nursing provided a final review.

(7) Once the American Pediatric Surgical Nurses Association, Inc. (APSNA) received an invitation from the Institute of Pediatric Nursing (IPN) to participate in the initiative, the APSNA Board was queried to identify pediatric nursing practices that should be modified based on evidence. The identified practice was presented to experts from APSNA’s Board of Directors, General Membership and Trauma Special Interest Group (SIG). The preliminary statement was reviewed and revised by content experts from both within and outside of the organization. Subsequently, the statement was submitted to the APSNA Board for final discussion and review. The final statement was reviewed and approved by the American Academy of Nursing.

Sources

Jauch, E., Saver, J., Adams, H., Bruno, A., Connors, J., Demaerschalk, B., Khatri, P., et al.( 2013) AHA / ASA guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association / American Stroke Association. Stroke. 44, 870-947.

Kenmuir, C., Hammer, M., Tudor, J., Reddy, V., Wechsler, L., Jadhav, A., (2015). Predictors of outcome in patients presenting with acute ischemic stroke and mild stroke scale scores. Journal of Stroke and Cerebrovascular Disease. 24(7) 1685-1689.

Martino, R., Maki, E., Diamant, N. (2014) Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST): Are 10 teaspoons of water necessary? International Journal of Speech-Language Pathology. 16 (3): 193-198.

Schepp, S., Tirschewll, D., Miller, R., Longstreth, W. (2012) Swallowing screens after acute stroke: A systematic review. Stroke. 43, 869-871.

Summers, D. Leonard, A., Wentworth, D., Saver, J., Simpson, J., Spilker, J., Hock, N…et al. (2009). Comprehensive overview of nursing and interdisciplinary care of the
acute ischemic stroke patient. A scientific statement from the American Heart Association. Stroke. 40, 1-35.