Abstract DP211: Improving Knowledge and Visibility of Dysphagia Aspiration Precautions with an Electronic Order Panel

Historically, Speech Language Pathology (SLP) dysphagia aspiration precautions and feeding guidelines were placed in an SLP note and posted on a paper bedside sign. In the past decade, these signs have decreased in popularity and/or been eliminated at the facility level due to limited effectiveness, infection control, HIPAA compliance, and the general shift towards digital communication. The purpose of this quality improvement initiative was to evaluate if electronic Dysphagia Aspiration Precautions (DAP) can be effective in helping nurses identify appropriate dysphagia precautions and improve implementation of those precautions. Pre and post surveys were conducted on 60 nurses in the neuroscience units across three campuses—Manhattan (M), Long Island (LI), and Langone Orthopedic Hospital (LOH)—to identify staff awareness regarding dysphagia precautions. Pre-intervention, nursing identified dysphagia 100% (M) and 90% (LI) of the time (LOH had no data); located the dysphagia aspiration precautions 57% (M), 94% (LI) and 90% (LOH) of the time; and identified the location of documentation of precautions 65% (M), 94% (LI) and 95% (LOH) of the time. An interdisciplinary team designed a DAP panel in the EMR. Additional steps included face testing the order panel, pre and post phase education with interdisciplinary teams, including providers and post-implementation chart abstractions. Following implementation of the panel, all sites demonstrated improvement in knowledge and implementation of DAP. DAP orders were “pended” by the SLP 100% of the time, and signed by the provider 100% of the time, at the six-week mark post go-live. Post-intervention nursing identified dysphagia 100%, 100% and 92% of the time; were able to locate DAP 82%, 100% and 100 % of the time; and completed initial documentation of DAP 94%, 90% and 87% of the time. An average of five precautions were ordered by SLP. Using informatics to transition recommendations from discipline-specific notes to an electronic, orders-based-workflow improved interdisciplinary communication, knowledge and adherence to patient-specific precautions. Future steps include exploring electronic-based-workflows with other precautions, identifying a key number of precautions that are consistently adhered to and documented on, and analyzing the impact to therapy documentation. Ideally, digital expansion would include caregivers via our electronic enterprise patient portal.