Touchstone Bronze: Aspiration Prevention is a Matter of Life or Breath

Note: The NHRMC system has earned seven 2019 Touchstone Awards from Atrium Health. Each of the initiatives will be profiled in blogs in advance of Atrium Sharing Day on August 7. 

In 2015, New Hanover Regional Medical Center formed an aspiration prevention team that included nurses, speech-language pathologists, registered dietitians, informatics clinicians, and food and nutrition services. 

In coordination with NHRMC Lean Strategies, the team embarked on an initiative to prevent aspiration in hospitalized patients. 

The project

            The team developed the following goals:

1. Identify risk factors for aspiration, for both oral and tube feeding.
2. Develop standard work to identify and manage patients at risk for aspiration, including clarification of the Aspiration Precautions order.
3. Empower nursing staff to initiate and discontinue aspiration precaution orders.
4. Develop processes for Food and Nutrition Services for delivering meals to patients on aspiration precautions.
5. Develop processes to ensure necessary suction is available bedside.
6. Ultimately, decrease onset of aspiration during hospitalization and save lives. 

The team proposed a number of countermeasures to implement once the nursing staff identifies the need for aspiration precautions, including:

1. Food and Nutrition staff are alerted to place an orange placemat on the patient’s food tray, which signals food restrictions.
2. Central Distribution is notified electronically to send a suction set-up to the patient’s bedside.
3. A laminated aspiration precautions sign is hung in the patient’s room to alert caregivers and family members
4. Patient’s head is consistently elevated.
5. A Best Practice Advisory appears in the Electronic Medical Record and indicates appropriate care plans and aspiration precautions
6. A clinical staff member is alerted when a patient’s meal tray is delivered. An unattended tray will not be left with a patient on aspiration precautions. 

The Impact

The primary benefit realized from this performance improvement process was the decrease in both acquired aspiration during hospital stay and associated mortality.  The program was initiated in November 2016, with positive results:

• Number of postadmission aspiration events decreased from 162 in 2015 to 154 in 2017.
• Number of deaths associated with aspiration complications decreased by 17.94%, from 39 in 2015 to 32 in 2017. 

Team Members

• Linda Thomas, BSN, RN, CNOR
• Laurie Lustiber, MS, CCC/SLP
• Christine Webb, BSN, RN
• Celeste Stephens, BSN, RN
• Angela L. Lago, MS, RD, LDN, CNSC
• Savonne Berrios, RN, CMSRN