Adapting foreign guidelines on post-stroke dysphagia identification and management to local context in China

Article type
Authors
Gao S1, Zhao J2, Guo H3, Wang J2, Tian R3, Ma J2, Li X2, Liu X2, Hao Y2, F Z4
1Peking University First Hospital
2School of nursing, Beijng University of Chinese Medicine; Beijng University of Chinese Medicine Joanna Briggs Institute center of excellence;Beijng University of Chinese Medicine; Beijng University of Chinese Medicine Best Practice Spotlight Organization
3Dongzhimen Hospital, Beijng University of Chinese Medicine; Beijng University of Chinese Medicine Best Practice Spotlight Organization;
4School of nursing,Beijing University of Chinese Medicine
Abstract
Background: Dysphagia is one common and severe symptom of post-stroke. Early identification and management can help to reduce the incidence of complications, lower medical cost and improve patients’ quality of life. Foreign guidelines relating to post-stroke dysphagia identification and management are abundant and mature, while they may not be totally suitable for China's situation and should be localised. It’s urgent to explore the way of localising foreign high-quality guidelines into China local context.

Objective: To evaluate the quality of evidence-based guidelines related to post-stroke dysphagia identification and management, translate guideline recommendations into specific clinical audit criteria.

Method: Search professional guideline websites; Database and Cross-media search engine with specific search terms and inclusion and exclusion criteria from 2010~2016 to obtain relevant guidelines. Critical appraisal the quality of final included guidelines with AGREE II. Rank those guidelines with A level, B level and c level. Extract recommendations related to post-stroke dysphagia identification and management in those A level guidelines and form the initial recommendation items pool. Select feasible recommendations from the initial pool and transfer those recommendations into clinical audit criteria both by stakeholder meeting.

Results: 5 pieces of evidence-based guidelines are finally included (Figure 1). The overall qualities are good. Two of them are ranked as A level guideline and the other three are rank as B level (Table 1). 24 recommendation items are extracted from those guidelines. Only 6 recommendations are selected to implement in the experimental unit according to the selection criteria. We transfer those 6 recommendations into specific clinical audit criteria by stakeholder meeting (Table 2).

Discussion: There’s still distance between China and foreign guideline development associations. The early identification and management are critical for patients’ overall health status. We shall resort to the best-available evidence to guide clinical nurses’ post-stroke dysphagia identification and management work.