Background: Aspiration, while hospitalized, can lead to increases in length of stay and health care costs. Nurses must identify patients at risk of aspiration early to initiate appropriate precautions. Local Problem: An increase in-hospital patient aspirations at a Midwestern hospital prompted a review of events, which identified opportunities to improve identification of patients' risk factors and completion of the bedside swallow screening. Methods: Interventions were identified via a causal factor tree analysis and an impact-effort grid then deployed using the Plan-Do-Study-Act (PDSA) methodology. Interventions: Interventions deployed included game based-learning, a unit-based champion, and the use of visual cues to identify patients at risk for aspiration. Results: After 3 PDSA cycles, documentation of patients' aspiration risk factors on admission increased by 40%, with a 51.3% increase in bedside swallow screening results. Conclusion: Iterative PDSA cycles successfully tested staff engagement strategies to improve aspiration risk and swallow screening documentation compliance.