Post-operative aspiration can cause complications like re-intubation, pneumonia, and can quickly become life threatening if a person is unable to get enough oxygen. After four aspiration-related deaths on the surgical oncology inpatient unit in the summer of 2017, an interprofessional working group was formed to review current practices and identify opportunities to reduce post-operative aspiration risk.
Literature shows that there is an increased risk of aspiration when lying flat and recommends those at risk to be in a fully upright position (90 degrees hip flexion) during and after mealtimes. Prevention guidelines also specifically highlight the benefits of sitting upright in a chair for meals. A unit audit in November, 2018, found that over 70% of patients on the surgical oncology inpatient unit were remaining in bed at mealtimes. This project served to work with patients, families, and staff to develop interventions to increase the number of patients sitting in a chair during mealtimes.
Patient surveys, staff surveys, and focus groups were used to identify how best to support patients to be sitting in chairs for mealtimes. Nine interventions were rolled out during this project, with the major interventions being (1) bedside education posters, (2) overhead mealtime announcements, (3) a patient engagement tool piloted with the hospital Healthy Stay Volunteer group, and (4) staff and volunteer lanyard cards.
Over a 6-month period with these new interventions in place, our team was able to more than double the rate of patients sitting in chairs during mealtimes.