Abstract T P332: Stroke Patient Education -A Story of Improvement

Abstract

Background: Rochester General Hospital (RGH) is a 559 bed acute care community hosp. in Rochester, N.Y. Designated as a Stroke Center in 2003, the Hosp. discharges 850 stroke & TIA pts. annually. The Stroke Coalition Team consists of members of the stroke pt. care areas & supporting depts. Group's purpose- provide a collaborative forum for sharing outcomes to improve stroke care. Each dept. has a core group to review actionable data for their areas. The Acute Stroke Unit (7800) Team’s purpose is to act on unit process improvement opportunities. May 2013- a negative trend with the Core Measure for pt. education was identified for the Coalition group. As a result, the 7800 leaders began investigating for root cause. Purpose of this QI program was to assure all pts. receive designated pt. education and documentation is complete. A secondary purpose was to improve the quality of the education. Methods: Four main barriers were identified: 1. RNs not understanding expectations 2. Novice RNs not comfortable in educating pts. and families 3. Electronic Medical Record (EMR)complexity - launched 11/12 4. Education complete but lacking documentation Action plan: 1 & 2. RN education A.Self-learning packet (SLP) that included: • Requirements of pt. education • How to document the education B. 1:1 support from CNS & Nurse Manager C. Daily chart audits to ID further opportunities & barriers to compliance D. RNs educated on teaching tools: •Welcome binder • AHA/ASA brochures for Stroke/TIA/diagnostic tests • Pt. educational TV offerings •Medical/nursing database 3. Complexity of EMR- Collaborated to make changes to the EMR templates. A. Automatic entry of the education template upon stroke order set B. Required education flagged C. Individualization of pt. education D. Standardized admission & discharge nursing notes 4. Lack of Documentation A. Discharge checklists made available B. Chart compliance audits (decreasing to random as compliance rose) Results: Rapid turn-around achieved. Recognized as best practice by Joint Commission during the Center’s 3/2014 re-designation. Conclusion: Rapid improvement possible with action upon data. Team approach allows for appropriate action to occur. Efforts continue to enhance compliance & pt. experience.