To Feed or Not to Feed: Dysphagia Screening Post-Extubation

Webinar Summary

Dysphagia is a potential complication of mechanical ventilation for patients in critical care units. Patients at highest risk are those with greater than 48 hours of intubation. The risk of postextubation dysphagia (PED) increases 25 percent after one day of intubation and doubles to 50 percent after just two days of intubation. Current practice for PED requires evaluation by a speech and language pathologist, which may result in patients being kept NPO 24-48 hours. Patients with PED are at risk for dehydration, malnutrition, aspiration of oral secretions and aspiration pneumonia. The consequences of PED include poor patient outcomes, increased length of ICU stay and additional costs totaling more than $500 million. Johnson and Speirs will present information on the value of PED screening of patients with prolonged intubation by nurses who are present with the patient 24 hours/day, seven days a week. Enhancing a nurse’s skill in identifying dysphagia would benefit critically ill patients, with timely evaluation and initiation of feeding helping to maintain adequate nutrition. The presenters will describe how nurses are already successfully performing dysphagia screening for post-stroke patients, medical patients in acute care and critically ill thermal burn patients using valid and reliable screening tools, as well as the potential for expanding this screening to patients with prolonged intubation.

Objectives

Describe complications, costs, and pathophysiology of postextubation dysphagia.
Distinguish between dysphagia screening and dysphagia evaluation.
Discuss criteria of good dysphagia screening tools and the clinical implications of their use.

Presenters

Karen L Johnson, PhD,RN,FAAN

Dr. Karen Johnson received her PhD in clinical nursing research from University of Kentucky. Her clinical background includes 25 years as a trauma/critical care clinical nurse specialist. She has held numerous faculty positions, teaching undergraduate and graduate critical care. She has been the director of nursing research for the past 10 years, focusing on clinical nursing research with direct application to nursing practice.

Lauri Speirs, MSN, RN, ACNS-BC, CNRN, SCRN

Lauri Speirs has been the Stroke Program clinical nurse specialist at John Peter Smith (JPS) Health Network in Fort Worth, Texas since 2014. Speirs holds a master’s in nursing from Grand Canyon University and certifications in progressive care, stroke and neuroscience nursing. She was awarded the JPS Excellence award in 2017 and Arizona’s Health Care Hero award in 2012. As part of her commitment to excellence, Speirs developed and teaches several classes to nursing staff at JPS. She is a member of the American Association of Critical-Care Nurses, American Heart Association, National Association of Clinical Nurse Specialists, and American Association of Neuroscience Nurses. In addition to poster presentations at various state and national conferences, Speirs co-presented Banner Health System’s stroke dysphagia screen at the National Association of Clinical Nurse Specialists’ conference in 2014.

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Learners must attend/view/read the entire activity and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.

Disclosure

This activity has been reviewed by the Nurse Planner. It has been determined that the material presented here shows no bias. No conflicts of interest have been identified for any individual with the ability to influence the content of this activity. Accreditation refers to recognition of continuing education only and does not imply AACN or ANCC approval or endorsement of any commercial products discussed or displayed in conjunction with this educational activity.

Accreditation

The American Association of Critical-Care Nurses (AACN) is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation, ANCC Provider Number 0012. AACN has been approved as a provider of continuing education in nursing by the California State Board of Nursing (CBRN), California Provider number CEP 1036. This activity is approved for 1.00 contact hours.

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