Abstract TP408: The First 24 hours Post-Stroke: Improving Timeliness of Blood Pressure Monitoring and Neurologic Assessment Completion
Background: In 2014 ischemic stroke orderset changes were implemented, increasing the frequency of blood pressure (BP) monitoring and neurologic assessments. Considering the significant practice change and criticality of the assessments, performance surrounding these specific order changes was evaluated. Data from a five month period (Feb 2014-June 2014) revealed the correct number of assessments completed in the first 24 hours was 50% (median) for BP and 64% (median) for neurologic assessments.
Purpose: Develop improvement initiative to increase adherence to stroke orderset monitoring frequencies.
Methods: To discuss current workflows and identify barriers to performance a quality improvement session was held with representatives from bedside staff, Neuroscience Unit leadership, and the Quality Department. Three improvement areas were identified: awareness regarding time sensitivity of assessments, variance in role completing BP monitoring, and patient inaccessibility at assessment due time. Focus areas were shared with the unit-based committee for action plan development. To address timing of assessments and provide a means of consistent communication, a bedside checklist was developed. To address variance in role completing BP monitoring it was decided that RNs would complete BP monitoring during the first 24 hours considering it coincided with the completion of the neurologic assessment. To address patients being inaccessible at assessment due times, it was decided that assessments would be completed prior to anticipated appointments that would otherwise prevent adherence to monitoring requirements.
Results: Data was collected monthly via electronic reports and manual chart review. After implementation of process improvement activities (July 2014-Mar 2015) the correct number of assessments completed in the first 24 hours was 94% (median) for BP and 96% (median) for neurologic assessments.
Conclusions: Bedside staff was highly engaged in this process improvement work. RNs found the bedside checklist to be an effective means of managing the frequent assessments necessary in caring for an acute stroke patient. A data focused improvement initiative resulted in consistent adherence to stroke orderset monitoring frequencies.
Author Disclosures: A. Barna: None. N. Kjos: None. J. McKee: None. H. Pronschinske: None.
- © 2016 by American Heart Association, Inc.