Abstract T P342: Clot Busting: Enhancing Nursing Documentation

Background: Stroke is the leading cause of death and disability in the United States. The only FDA-approved treatment of ischemic stroke is tissue plasminogen activator (rt-PA) which dissolves the clot and improves blood flow to the compromised brain area(s). According to the National Institute of Neurological Disorders and Stroke rt-PA Study Group, 6.4% of patients treated with rt-PA experienced a hemorrhagic conversion. Thus, it is critical to closely monitor neurologic status (neurologic exam and vital signs) during treatment. During the Joint Commission Comprehensive Stroke Certification (CSC), we identified opportunities for improvement in our documentation of neurological status for our patients receiving rt-PA. Purpose: Following the Iowa Model of EBP to promote quality patient care, our purpose was to develop a standardized guideline for neurological assessment and documentation for patients following administration of rt-PA. Our goal was to attain a 90% compliance rate for appropriate neurological assessment documentation. Methods: Based on research, the American Heart Association clinical guidelines, and consultation with a CSC and our Regulatory Compliance department, we developed the standardized documentation guideline. The project included strategies addressing the four process phases required to implement and integrate EBP. Strategies included: 1) education on standards utilizing information sessions at staff meetings, tip sheets, and badge cards, 2) standardization of neurological assessment in EMR, 3) utilization of the stroke page system for patient identification, and 4) audit and feedback loops with just-in time in-servicing. Results: Prior to the implementation of this standardized guideline, of the 14 patients who received rt-PA, 14% met the threshold goal; of the 10 patients who received rt-PA after our implementation, all patients met the threshold. Conclusions: Through the implementation of our standardized protocol for neurological assessment and documentation of patients following administration of rt-PA, we were able to improve the quality of neurological assessments, meet Joint Commission requirements, and improve the quality of patient care.