Hemphill et al Performance Measures for ICH e255 Appendix. Continued 6. Passed Dysphagia Screen Before First Oral Intake of Fluids, Nutrition, or Medications: Percentage of patients 18 y of age with a diagnosis of ICH who were documented to have passed the most recent dysphagia screen before oral intake Numerator Included patients: Patients who were documented to have passed* the most recent dysphagia screen before oral intake of fluids, nutrition, or medications Excluded patients: Patients whose first oral intake was not consistent with the recommendations of the most recent dysphagia screen (eg, a patient was provided thin liquids, although the recommendation was for thickened liquids) Denominator Included patients: All patients 18 y of age with a diagnosis of ICH who received oral nutrition, fluids, or medication during the hospital stay Excluded patients: Patients who remained nil per os during the entire hospital stay <18 y of age Length of stay >120 d Enrolled in a clinical trial related to stroke that would affect dysphagia screening Period of Assessment Once during each hospital stay Sources of Data Prospective flowsheet, retrospective medical record review, electronic medical record Rationale Dysphagia is present in up to 67% of patients with acute stroke, and of these, almost 50% have aspiration, a prerequisite for aspiration pneumonia. Up to one third of patients who aspirate develop pneumonia. Pneumonia is a serious complication of stroke and is associated with increased mortality. Several studies have demonstrated a reduction in pneumonia after institutional implementation of dysphagia screening protocols but without randomized control groups. Several swallow screening methods have been published in the literature, each with benefits and limitations, without sufficient evidence to recommend a single consensus method. 