Abstract:

Objective: To explore the effectiveness of multi-disciplinary graded collaborative management on swallowing screening and intervention in patients with chronic obstructive pulmonary disease (COPD). Methods: Data were collected on COPD participants who received swallowing screening and intervention from May to October 2022 in The Third Affiliated Hospital, Sun Yat-sen University. Intervention was composed of the followings: (1)A multidisciplinary management team was established. (2)A swallowing function screening and intervention process for patients with COPD was developed. (3)A multidisciplinary graded collaborative management process and feeding management routine were formulated, training program and quality control program were developed. (4) Nurses were trained and assessed. Results: A total of 186 patients with COPD were screened, of whom 43 had swallowing disorders, with a positive rate of 23.12% (43/186). After the implementation of multidisciplinary graded collaborative management, the swallowing screening rate of patients was 100.00% (186/186),the intervention rate of positive patients based on the volumetric viscosity swallowing test results was 100.00% (43/43), the consultation rate of nutrition swallowing specialist nurses was 24.19% (45/186), the consultation rate of nutrition doctors was 19.89% (37/186), and the consultation rate of swallowing rehabilitation therapists was 5.91% (11/186). After intervention, the average body weight ((61.21±10.99) kg), hemoglobin ((132.44±11.27) g/L), serum albumin ((37.63±3.51) g/L) and serum prealbumin ((199.77±40.15) mg/L) of the 43 positive patients were all increased than those before intervention (respectively (59.99±10.96) kg, (124.67±10.86) g/L, (35.01±2.82) g/L, (177.12±40.09) mg/L, (t=-9.871, -8.634, -7.708, -11.703, all P<0.001)); After intervention, the average nutritional risk NRS 2002 score (2.47±0.74), the incidence of dominant aspiration (16.28% (7/43)) and aspiration pneumonia (2.33% (1/43)) were lower than before intervention (respectively (3.53±0.91), 89.74% (35/39), 35.90% (14/39), (t=10.488, χ²=44.177, 0.245, all P<0.001)); After intervention, the average clinical nutrition and swallowing theory scores (86.43±3.80) and skill scores (87.29±2.51) of the specialist nursing team were increased than those before intervention ((76.00±6.04) and (76.76±4.95), respectively, t=-10.890, -8.584, P<0.001). Conclusion: Routine screening of swallowing function in patients with COPD and multi-disciplinary graded collaborative management can reduce the nutritional risk of patients, improve the safety of patients’ feeding and promote the refined development of specialized nursing care.

Key words: Pulmonary disease, chronic obstructive, Deglutition disorders, Intervention studies