Doctor of nursing practice (DNP) quality improvement (QI) project : implementation of a nurse-driven bedside swallow screening protocol in a pediatric intensive care unit (PICU)

Problem: Pediatric dysphagia is associated with delayed oral intake, prolonged length of stay, and increased risk of complications. In pediatric intensive care units (PICUs), reliance on speech-language pathology (SLP) consultation may delay timely evaluation and intervention. Standardized nurse-driven bedside swallow screening protocols are well established in adult populations but remain limited in pediatric practice. Purpose: The purpose of this quality improvement (QI) project was to implement a nurse-driven bedside swallow screening protocol in a PICU to promote early identification of dysphagia and improve nursing confidence in assessing swallowing function. Methods: Guided by the Institute for Healthcare Improvement Model for Improvement and Plan-Do-Study-Act cycles, a pediatric-adapted screening protocol based on the Yale Swallow Protocol was implemented. Eligible participants included post-extubation PICU patients meeting defined age and clinical criteria. Interventions included staff education and integration of the screening tool into the electronic health record. Data collection included screening outcomes, protocol adherence, time to diet initiation, and nursing feedback surveys. Results: Of 71 eligible patients, four met inclusion criteria and completed screening. Two patients passed and advanced to oral intake, while two failed and received SLP consultation. Median time from extubation to screening was 64.5 minutes. Nursing survey responses (n = 3) demonstrated high confidence, ease of use, and no reported safety concerns. Protocol adherence varied, particularly in order placement, documentation, and repeat screening. Conclusions: Implementation of a nurse-driven bedside swallow screening protocol in the PICU was feasible and supported nursing confidence without identified safety events. Continued evaluation with a larger sample is needed to assess impact on clinical outcomes and process reliability.

Author dc:creator

• Gotham, Caitlin

Contributors dc:contributor

• Winowiecki, Joshua M. (Joshua Michael)

• Deglutition disorders--Diagnosis
• Deglutition disorders in children
• Intensive care nursing
• Nursing assessment

Statement dc:rights

• In Copyright

Language dc:language

English

Identifier

dnp:89
oclc:1601633911
local:R_1Mtc4K9zANZx7i3

OAI identifier oai:identifier

oai:d.lib.msu.edu:dnp_89