脳卒中による摂食・嚥下障害患者の退院時情報の正確さと継続性

脳卒中による摂食・嚥下障害患者の退院時情報の正確さと継続性を調査した、スウェーデンの論文を紹介します。

Carlsson E, Ehnfors M, Eldh AC, Ehrenberg A: Accuracy and continuity in discharge information for patients with eating difficulties after stroke. J Clin Nurs. 2011 May 12. doi: 10.1111/j.1365-2702.2010.03648.x.

脳卒中による摂食・嚥下障害患者15人について、カルテ、退院時サマリー、看護師へのインタビューで。摂食・嚥下障害の記録や退院時連携について調査しました。

その結果、MNA-SFで15人中13人が低栄養、2人が低栄養のリスクありで、十分なリハを受けるには栄養状態が不良であったにもかかわらず、摂食・嚥下障害の記録や退院時連携の情報はプアでした。栄養障害に対する明らかなケアプランも欠落していました。

スウェーデンでも栄養や嚥下に関する地域連携は看護師レベルではかなり不十分といえます。日本では脳卒中の連携パスでかなり状況は改善しつつあると思いますが、それでも栄養や嚥下に関する情報は連携パスの中には少ないため、私は神奈川摂食・嚥下リハ研究会のNST・嚥下連絡票を使用することを推奨しています。

http://kanagawaenge.web.fc2.com/

Abstract
Aims.  To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke. Background.  Eating difficulties are prevalent and serious problems in patients with stroke. Screening for eating difficulties can predict undernutrition and subsequent care needs. For optimal care, information transferred between care settings has to be comprehensive and accurate. Design.  Prospective, descriptive. Methods.  The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics. Results.  Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities. Conclusions.  Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking. Relevance to clinical practice.  Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.