BACKGROUND Postextubation is common in the intensive care unit, and bedside screening by nurses is important to detect the condition and avoid aspiration to the airways. OBJECTIVE The objective of this study was to assess the implementation of nurse-led, systematic dysphagia screening in the intensive care unit and to identify barriers and facilitators for dysphagia screening. METHODS Design: pragmatic implementation study. Based on a programme theory, key behaviours were identified using the Behaviour Change Wheel framework. Implementation activities included education, e-learning, bedside peer support, feedback, and cues in the environment. Data sources included chart reviews, participant logs, implementation log and focus-group interviews. RESULTS Participant logs showed 94% of nurses participated in educational sessions, less in e-learning (67%). Chart reviews showed very little use of nurse-led dysphagia screening. Only 19% of extubated patients followed screening protocol. Focus groups showed that nurses accepted the Yale Swallow Protocol as valid that new skills and understandings led to empowerment of nurses and aided decision making. Important barriers were keeping patients nil-per-mouth for intubation, lack of social support from other professionals, and difficulties with documentation. Facilitators were social support from colleagues. CONCLUSION Implementation of nurse-led screening in intensive care was possible but challenged by external factors. Attention should be given to alterations of the screening protocol to avoid alteration of the instrument and easy documentation. Implementation of nurse-led dysphagia screening in intensive care may facilitate safe oral intake in patients and identify patients in need of specialised assessment. Implementation should aim to provide nurses with competences in screening patients swallowing function and allow contextualisation without altering the properties of the instrument.

中文翻译：

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重症监护室护士主导的吞咽困难筛查 - 一项实施研究。


背景拔管后在重症监护室很常见，护士的床边筛查对于检测病情并避免误吸气道非常重要。目的 本研究的目的是评估重症监护病房中护士主导的系统性吞咽困难筛查的实施情况，并确定吞咽困难筛查的障碍和促进因素。方法设计：务实的实施研究。基于程序理论，使用行为改变轮框架识别了关键行为。实施活动包括教育、电子学习、床边同伴支持、反馈和环境提示。数据来源包括图表审查、参与者日志、实施日志和焦点小组访谈。结果 参与者日志显示 94% 的护士参加了教育课程，较少参加电子学习 (67%)。图表审查显示，护士主导的吞咽困难筛查很少使用。只有 19% 的拔管患者遵循筛查方案。焦点小组表明，护士们接受《耶鲁吞咽协议》的有效性，认为新的技能和理解可以增强护士的能力并辅助决策。重要的障碍是患者无法插管、缺乏其他专业人员的社会支持以及记录方面的困难。协调者是来自同事的社会支持。结论 在重症监护中实施护士主导的筛查是可能的，但受到外部因素的挑战。应注意筛查方案的变更，以避免仪器和简易记录的变更。在重症监护室实施护士主导的吞咽困难筛查可能有助于患者安全口服摄入并识别需要专门评估的患者。 实施的目的应是为护士提供筛查患者吞咽功能的能力，并允许在不改变仪器特性的情况下进行情境化。