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20th March 2024

Better together: Care bundle shows benefits for stroke patients

Joanne Murray

A new protocol designed to boost fundamental care in acute stroke patients has shown signs of significant improvement following the success of a pilot project. 

Thanks to your donations, the “Screen-Clean-Hydrate” care bundle was able to be rolled out in the Lyell McEwin Hospital (LMH) and Flinders Medical Centre (FMC) last year in an Australian first. 

The protocol aimed to address dysphagia (impaired swallowing) and other adverse outcomes by combining separate components into one streamlined process. 

Led by Dr Joanne Murray from Flinders University, the project was the culmination of a decade’s worth of research. 

“The idea came from the three interconnected streams of research that I’ve been leading over the past 10 years – swallow screening, oral care and hydration – which was aimed at improving care for people with swallowing difficulties after a stroke,” she said. 

“After trying for many years to get improvement in care in each area, I decided to try and bundle them together.” 

Aspiration pneumonia, dysphagia and dehydration are some of the most frequent complications that occur in stroke patients, resulting in longer hospital stays, increased risk of stroke reoccurring and a higher mortality rate. 

But this can be minimised by early screening, maintaining good oral hygiene and properly hydrating. 

Australian clinical guidelines recommend that patients be screened for dysphagia within four hours of admission, their hydration status assessed and monitored, and oral hygiene maintained throughout their stay. 

But a national audit of acute services in 2023 found less than 30% of patients were swallow screened within the four-hour window, and less than 6% of hospitals had oral care protocols in stroke units. 

Screen-Clean-Hydrate combined swallow screening and assessment of hydration status within four hours of admission and an oral health assessment within 24 hours, into one checklist. 

Dr Murray said both sites improved their care practices because of the project. 

At FMC, hydration assessment went from non-existent to 40% compliance, while oral care delivery jumped to 80%. 

For LMH, compliance with individual oral care planning (3% vs 77%) and hydration assessment (7% vs 60%) were the most notable improvements. 

“Overall complication rates for patients did not improve at either site, although there were fewer urinary infections after implementation at both sites,” she said 

“The reason for this may have been increased vigilance of patient outcomes by clinical staff and increased testing with associated documentation.” 

The project is now well positioned to expand regionally, which will help provide further evidence of the bundle’s health benefits.