Variability in Nurse-Administered Swallow Screens for Patients After Acute Stroke: Insights From the Electronic Health Record.

PURPOSE: Nursing-driven swallow screens are a critical component of poststroke dysphagia evaluations to prevent aspiration and pneumonia. There are multiple screening protocols but no consensus tool. This study aimed to characterize variations in nurse-administered swallow screening documentation for poststroke patients by examining templates in the electronic health record (EHR) and comparing them to established protocols.

METHOD: Between August 2023 and January 2024, the keywords "stroke swallow screen" were searched in the Epic Community Library, a public database of documentation templates from institutions using the Epic EHR. Adult inpatient nurse-administered swallow templates were included. Pediatric, emergency department, speech-language pathology, and nonswallow screen templates were excluded. Data including hospital location, setting (academic, community, international), and protocol details of oral trials were recorded.

RESULTS

Of 157 included templates, nearly all (152/157, 96.8%) incorporated water during oral trials, with 3 oz/90 mL as the most common specified volume (n = 115). Fewer than half (71/157, 45.2%) aligned with established screening protocols; the most frequently identified were the Yale Swallow Protocol (35/157, 22.3%) and the Barnes-Jewish Hospital-Stroke Dysphagia Screen (23/157, 14.6%). No significant association was found between institution setting and presence of an established screening protocol (p > .05).

CONCLUSIONS

Review of nurse-administered swallow screening documentation templates for patients after acute stroke highlights substantial variability despite widespread use of water-based trials. Most templates did not align with an established protocol. These findings suggest an opportunity to standardize documentation across hospital systems to support consistent practice and reduce adverse outcomes related to dysphagia after stroke.