Abstract 64: Utilization of Best Practice Guidelines and Multidisciplinary Work Flow Analysis to Improve System Wide Post-Cerebral Angiogram Assessment
Background: as a Joint Commission (TJC) certified Comprehensive Stroke Center (CSC), we managed a total of 797 cerebral angiogram cases over the last 15 months. During a TJC survey site visit, inconsistencies between post-angiography nursing hand-offs and documentation of assessments were identified. As a result, a large scale process improvement initiative was organized by a team of Stroke Nurse Practitioners. Objectives: The key objective was to improve the post-angiography hand off and assessment performance to > 90%; Complete a work flow analysis of this process and define critical barriers; Compare existing practice to best practice guideline and develop, implement, and evaluate a comprehensive PI plan. Methods: Search of common electronic databases and guidelines to identify post-cerebral angiography complications and evidence based guidelines for post-procedure nursing assessment and transition; Auditing of 100% of the cerebral angiogram cases during the defined time period. Survey of practice policies utilized by other certified CSCs and GWTG sponsored CSC collaborative networking activities; Coordinated development of an EMR based abstraction program for data capture and designed a desktop analysis tools. Results: TJC compliance standard of > 90% performance was demonstrated and sustained. Multiple barriers were identified which lead to the development of targeted interventions associated with nursing practice and policies, electronic order sets that highlighted inconsistency in post-procedure orders and discrepancies in knowledge and practice among nurses. The most crucial intervention proved to be standardization of the cerebral angiogram order sets resulting in an almost immediate 14% improvement. Conclusion: This clinical application project validated the importance of standardizing care practices, pathways, documentation, training and tools to sustain a system wide improvement in post-angiography assessment. The project also demonstrated the value added role of a team of specialized advance practice nurse practitioners and clinical specialists in leading multidisciplinary stroke practice change.
Author Disclosures: V. Johnson: None. K. van Groos: None.
- © 2015 by American Heart Association, Inc.