Abstract

Background
Stroke is increasing in low-middle-income countries. Stroke unit care including evidence-based practice e.g., swallowing and hydration protocols, are associated with reduced disability and mortality.

Objectives
To co-design a swallow and hydration Care-Bundle for nurses to use with acute stroke patients. To implement and evaluate the swallowing and hydration Care-Bundle on three acute stroke units across India.

Methods
A multi-centre, pre- and post-implementation feasibility study was conducted. We co-designed a Care-Bundle (with stakeholders) which included the Global Evaluation of Swallowing and hydration screening and related actions/management. Implementation used clinical champions, education and training, barrier and enabler identification, and site support.

Participants included consecutively admitted patients, ≥18 years, with clinical diagnosis of acute stroke, a persistent neurological deficit on presentation and were admitted to a study site within two weeks of stroke onset.

Results
Fifty-three healthcare staff completed the Care-Bundle training. We recruited 183 participants, pre-implementation group (n=92). Swallow evaluations using different consistencies increased from 22 (23.9%) to 51 (56%). Calculated osmolarity (cOsm) increased from 0 to 66 (73%) participants. Median cOsm was 288 mmol/L (IQR 280 mmol/L to 295 mmol/L), 15 (23%) participants were dehydrated.

Conclusion
Care-Bundle implementation was feasible and improved swallowing and hydration management in three sites in India.