Table 2 Implementation strategies

Workshop

[16, 37, 38]

The learning activities consisted of an e-learning program, an interactive lecture, case studies and practical training in dysphagia screening. The content of the e-learning program was anatomy and physiology related to swallowing, and dysphagia, swallowing screening and measures aimed at swallowing deficits. In addition, we went through our local procedure on dysphagia screening.

The workshop lasted for three days with an hour duration on the first 2 days, and 2 1/2 h on the last day. All nurses on the unit attended the workshop.

Local opinion leaders

[39,40,41]

With the assistance of management, we identified local opinion leaders in the stroke unit. This was respected nurses with knowledge and skills in acute stroke treatment. The local opinion leaders were active throughout the entire implementation and re-audit period. They taught at the workshop, supervised novice nurses, administered the manual paper reminders and they talked about the importance of the project at the unit.

Manual paper reminders

[41]

Checklists were used to remind the staff of swallow screening.

We developed cards to put on the patient’s bedside table to remind the staff not to give the patient food or drink before swallow screening.

Feedback

[42]

We gave feedback to the management and the staff on the level of care in plenaries. We did this one time on baseline and three times during data collection for re-audit. During these plenaries we discussed challenges and questions that related to the swallow screening.