Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Implementing the Screen-Clean-Hydrate Bundle of Care for Improving Swallow Screening, Oral Health and Hydration in Acute Stroke (#125)

Joanne Murray 1 2 , Sulekha Gunasekaran 1 , Sebastian H Doeltgen 1 2 , Stacey George 1 , Kathleen Parr 3 , Christopher Dry 4 , Michelle Hutchinson 3 , Matthew Willcourt 5 , Jana Havlis 6 , Gillian Harvey 1
  1. Caring Futures Institute, Flinders University, Adelaide, SA, Australia
  2. Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, SA, Australia
  3. Nursing, Southern Adelaide Local Health Network, Adelaide, SA, Australia
  4. Allied Health, Southern Adelaide Local Health Network, Adelaide, SA, Australia
  5. Neurology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
  6. Speech Pathology, Northern Adelaide Local Health Network, Adelaide, SA, Australia

Background: Stroke guidelines recommend care processes that optimise patient outcomes, minimising hospital-acquired complications (HACs). However, audits and surveys of practice illustrate recommended care is not consistently/thoroughly implemented.

 

Aims: This study implements and evaluates a new bundle of care, Screen-Clean-Hydrate (S-C-H), which aims to improve compliance with guidelines for swallow screening within 4-hours of presentation, and routine assessment and management of oral healthcare and hydration. With improved care processes, HACs such as aspiration pneumonia, dehydration, and other infections/morbidities may reduce.

 

Methods: This Type-2 Hybrid Effectiveness/Implementation pre-post study is being conducted in two Australian acute stroke units. The integrated-Promoting-Action-on-Research-Implementation-in-Health-Services (iPARIHS) framework is guiding study design, implementation and evaluation. Clinical effectiveness of S-C-H is measured by rates of ICD-10AM-coded HACs, length of stay and procedure costs for 60 patient participants. Implementation is measured by acceptability, feasibility, uptake and fidelity of S-C-H, with identification of barriers and enablers through staff interviews, medical record audits and researcher field notes.

 

Results: Pre-implementation audits from 30 patient participants at each hospital revealed compliance with 4-hour swallowing screening of 90% and 53% respectively, oral health assessment 95% and 43%, oral healthcare planning 0% and 13%, documented oral healthcare delivery 25% and 23%, documented hydration assessment 0% and 0%, and documented hydration management plan 44% and 43%. Nine patients developed HACs.

Implementation strategies have included education, web-based resources and training, maximising functionality of electronic medical record system, identifying oral health champions, redefining interprofessional roles, visual reminders and posters in bathrooms and at bedside for patients, weekly targeted audits of care processes and feedback cycles, and nursing documentation audits.

Post-implementation evaluation of 30 patient participants at each site occurs May-July 2023. Process evaluation and analysis of implementation strategies follows.

 

Conclusion: Preliminary findings suggest S-C-H is acceptable, feasible and improves care processes. Results will inform a future multi-site effectiveness/implementation study.