Abstract T P329: Coo-Coo For Compliance: Improving Compliance of Acute Stroke Patient Documentation
Introduction/Background: As a Joint Commission Comprehensive Stroke Center we are charged with the task of meticulous monitoring of vital signs and neurologic status after thrombolytic therapy to prevent complications. This can be difficult to document in real time. In accordance with best practices and the AHA guidelines and the American Association of Neuroscience Nurses, we sought to improve the documentation of vital signs and neurologic evaluations during and after t-PA. During our Joint Commission Comprehensive Stroke Survey we were cited for improving the documentation of vital signs and neurological checks after t-PA.
Background: We identified nurses were starting documentation at awkward times, i.e. 1538 and attempting to add 15min to this time over a 24 hour period. The nurses were educated about rounding up to the 15min mark, making it easier to add 15min each time. We auditied documentation of every patient who received Acute Stroke Treatment, and sent feed back to nurses in “real time”. We discovered transportation from one department to another caused missed documentation. A transport monitor was purchased that can easily take a full set of vital signs during transport, and nurses were instructed to “back time” the documentation. We found that intensive documentation required the nurse to sift through multiple screens to document findings. The entire neuro team collaborated to create a Stroke Navigator for EPIC. This navigator contains all pieces of expected documentation of the stroke patient in one area of EPIC.
Conclusion: From January to December 2013, our Stroke Team saw 970 patients. 82 were treated with IV tPA, 18 were sent for Interventional clot retrieval, 6 received both IV tPA and Interventional clot retrieval, and 4 received tPA at another facility and transported to Cedars Sinai for higher level of care. We found issues within the system, that increased the chances of having vital documentation missed, or delayed by the nursing staff. Prior to the implementation of these new strategies our compliance rate with documentation was 32%. The results after the implementation of our new strategies were staggering. Our nurses were 94% compliant with documentation.
Author Disclosures: N.E. Wolber: None. L. Paletz: None. N. Steiner: None. B. Robertson: None. S. Guerra: None.
- © 2015 by American Heart Association, Inc.