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​​Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures)

Below are some recommended measures to use, as appropriate, to track your progress.  In selecting your measures, consider the following:

  • Whenever possible, use measures you are already collecting for other programs.
  • Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.
  • Try to include both process and outcome measures in your measurement scheme.
  • You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others'.
  • Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2011).

For more information on measuring for improvement contact the Canadian Patient Safety Institute Central Measurement Team at measurement@cpsi-icsp.ca

Outcome Measure

  1. Incidence of documented aspiration pneumonia and pneumonitis in critical care patients.
  2. Incidence of documented aspiration pneumonia and pneumonitis in the older adult with dysphagia.
  3. Incidence of documented aspiration pneumonia and pneumonitis in patients who are tube fed.

Process Measures

1.    Percent of patients with risk assessment for aspiration pneumonia and pneumonitis.

2.    Percent of patients at high risk for aspiration pneumonia and pneumonitis with an individual plan of care.

3.    Percent of critically ill patients meeting the following prevention bundle criteria:

    • Maintain head-of-bed elevation at an angle of 30 to 45 degrees, unless contraindicated.
    • Use sedatives as sparingly as feasible.
    • Meet tube feeding protocol (see below).
    • Obtain a swallowing assessment before oral feedings are started for recently extubated patients who have experienced prolonged intubation.
    • Maintain endotracheal cuff pressures at an appropriate level, and ensure that secretions are cleared from above the cuff before it is deflated.

4.    Percent of older adults with dysphagia meeting the following bundle criteria for aspiration prevention during feeding:

    • Provide a 30-minute rest period prior to feeding time.
    • Sit the person upright in a chair; if confined to bed, elevate the backrest to a 90-degree angle.
    • Use the chin-down or chin-tuck maneuver in patients for whom swallowing studies have determined to be beneficial.
    • Adjust rate of feeding and size of bites to the person's tolerance.
    • Alternate solid and liquid boluses.
    • Vary placement of food in the person's mouth according to the type of deficit.
    • Use the food viscosity that is best tolerated by the individual.
    • Minimal use of sedatives and hypnotics.
    • Avoid medications that dry up secretions.
    • Avoid distraction while feeding.

5.    Percent of tube fed patients meeting the following bundle criteria for aspiration prevention during tube feeding:

    • Keep the bed's backrest elevated to at least 30 degrees during continuous feedings.
    • Assess placement of the feeding tube at four-hour intervals.
    • Assess patients for signs of gastrointestinal intolerance at four hour intervals.
    • Measure gastric residual volumes every four to six hours during continuous feedings and immediately bef​ore each intermittent feeding.
    • Use a promotility agent when an adult patient has two or more gastric residual volumes ≥ 250 ml.
    • Avoid bolus feedings in those at high risk for aspiration.
    • Percent of pediatric patients with dysphagia meeting the following bundle of criteria for aspiration prevention during feeding:
  • Use of appropriate positioning or seating equipment.
  • Use of appropriate feeding tools.
  • Appropriately modified texture and size of food.
  • Appropriately modified consistency of liquids.
  • Appropriately paced introduction of boluses.