Abstract TP473: Stroke Care and Mental Health: Improving Patient Care With National Institutes of Health Stroke Scale Certification of Registered Nurses

Abstract

Stroke Care and Mental Health: Improving Patient Care with National Institutes of Health Stroke Scale Certification of Registered Nurses Background: Numerous risk factors increase likelihood of stroke for the chronic mentally ill; best practice for care of acute stroke includes early recognition and early assessment using a scoring tool. The identified gaps in facility practice included: (a) a lack of acute stroke recognition and assessment skills by medical emergency response RNs; (b) outdated and lack of practice guidelines for medical care of acute stroke patients; and (c) non-standardized RN handoff communication to receiving stroke care center. The focus was a change in practice providing guidelines for assessment and documentation of National Institutes of Health Stroke Scale (NIHSS) score thus standardizing handoff communication. Purpose: The purpose of this quality improvement (QI) project was to improve the recognition and assessment skills of RNs responding to acute stroke emergencies at a Department of Veterans Affairs psychiatric care facility. Method: Data were collected before and after completion of NIHSS certification. The convenience sample (N=10) was drawn from medical emergency response RNs. Participants chose random identifiers and were given a pre-implementation questionnaire measuring level of comfort with identifying and assessing acute stroke symptoms and comfort using the NIHSS tool. Participants completed certification and using their selected identifier completed a post certification questionnaire. A retrospective chart review was conducted to review acute stroke emergencies and use of the NIHSS tool. Lippitt’s Change Theory was the framework utilized to implement the change in practice. Results: Improvement in skills of acute stroke recognition and assessment, comfort when caring for acute stroke patients, and a marked increase (59%) in the use of a stroke assessment tool was noted after the intervention. Conclusion: Despite a small sample size the outcomes of the QI project were positive. RNs providing medical emergency response treatment at a psychiatric facility noted an increase in comfort levels in recognition, assessment, and care of acute stroke emergencies. Expansion of the QI project can be beneficial.