Oral intake of solid medications in patients with post-stroke dysphagia. A challenge for nurses?

Aim: To provide a comprehensive overview of how stroke nurses manage solid medication (SM) delivery to patients with post-stroke dysphagia.

Design: Cross-sectional study.

Methods: A self-administered online survey was carried out among nurses in German-speaking countries between September and December 2021.

Results: Out of a total of 754 responses, analysis was conducted on 195 nurses who reported working on a stroke unit. To identify swallowing difficulties in acute stroke care, 99 nurses indicated routinely administering standardised screenings, while 10 use unvalidated screenings, and 82 are waiting for a specialist evaluation. Regardless of whether screening methods are used or not, most preferred a non-oral route of medication administration for patients with suspected dysphagia. None of the respondents reported administering whole SMs orally to patients. If screening methods indicate dysphagia, approximately half of the respondents would modify SMs. Participants who stated to use the Gugging Swallowing Screen managed the SM intake guided by its severity levels. One-third of the group who awaited assessment by the dysphagia specialist provided modified medication before the consultation.

Conclusion: Most of the nurses on stroke units use swallowing screens and avoid the administration of whole SMs in post-stroke dysphagia. In addition to the non-oral administration, SMs are modified if dysphagia is suspected. Precise guidance on the administration of SM is needed, based on screening tests and prior to expert consultation.

Trial And Protocol Registration: ClinicalTrials.gov: Registration ID: NCT05173051/ Protocol ID: 11TS003721.

Implications For The Profession And/or Patient Care: The present paper serves to alert nurses to the issue of patient safety when administering medication for acute stroke-induced dysphagia.

Impact: SM delivery after acute stroke-induced dysphagia is often neglected. While nurses are aware of the risk associated with dysphagia and would not give whole SMs to patients, the modification of tablets and their administration with semisolids are common.

Reporting Method: This study was reported according to the Checklist for Reporting of Survey Studies (CROSS).