aspiration, aspiration pneumonia, dysphagia, risk assessment, prevention



  1. Cipra, Elizabeth J. DNP, RN, APRN-CNS, CCRN-K


Background: Aspiration pneumonia is one of the most common forms of pneumonia in hospitalized adults. Aspiration is potentially preventable when healthcare providers take action to decrease its occurrence. Standardized protocols can improve consistency with identification, assessment, and treatment of hospitalized patients at risk of aspiration pneumonia.


Problem/Purpose: There was no process in place to identify patients at risk of aspiration who did not present with stroke symptoms. The aims of this project were to assess that action steps were taken in patients who assessed positive for aspiration risk and to determine the aspiration risk assessment tool's impact on the incidence of aspiration pneumonia.


Methods: After implementing an adapted evidence-based aspiration risk assessment tool and aspiration precautions protocol, consistency of actions taken was assessed descriptively, and rates of aspiration pneumonia were compared from preimplementation to postimplementation using [chi]2 analysis.


Interventions: An aspiration risk assessment tool was adapted to include local hospital findings and implemented.


Results: All adult patients admitted (n = 10 973) during the initial evaluation period (July 2016 to December 2016) were screened using the adapted aspiration risk assessment tool. Three hundred twenty-six patients (19%) were identified at risk of aspiration and referred to speech therapy for evaluation, with 87.1% evaluated in less than 24 hours. Signs for aspiration risk and speech therapy recommendations were posted on 40% (n = 12). During the 18-month preintervention and postintervention period, hospital-acquired aspiration pneumonia decreased from preimplementation (n = 58 cases/26 738 admissions, 0.22%) to postimplementation (37/28 164, 0.13%), P = .018.


Conclusions: Implementation of an adapted aspiration risk assessment screening tool to document risk of hospital-acquired aspiration pneumonia and aspiration precautions protocol was associated with a decrease in aspiration pneumonia rates.