Abstract WP31: Really, Did A Code Stroke Simulation Improve Compliance In Patient Care Requirements?

Abstract

Purpose: Enhance the care of ischemic stroke patients by improving compliance with implementation of appropriate order sets, following protocols addressing assessment of vital signs, neuro checks, and lowering door to needle times. Method: ED nurses were required to attend one of five simulation skills fair offered over a nine month period. A stroke simulation scenario was provided in the simulation lab. Groups of nurses performed each step in the care of a code stroke patient. An ED nurse facilitated each step to assure the staff had an understanding of time related events such as calling code stroke, identifying the exact time of last seen well, obtaining CT, vital signs, labs, neuro checks, scoring the patient, and administration of Alteplace, if applicable. Results/Outcomes: Metrics for fiscal year were compared to the statistics collected for the last quarter of fiscal year. Implementation of the stroke order set rose 56.4%, from 43.6% to 100%. Compliance with the protocol, neuro checks improved 40% to 90% and documentation of vital signs per protocol rose from 90% to 97%. Door to needle time improved by 11 minutes. Implications: The simulation educational intervention proved to show a significant improvement in compliance in performing vital signs, neuro checks, using stroke order sets and especially door to needle times. The ED leadership team has recognized the significant impact to our patient care outcomes and compliance resulting from providing this simulation education. The simulation also identified that the majority of the staff did not understand how to correctly perform neuro checks and were not placing the correct code stroke order sets that included the orders to do vital signs and neuro checks per protocol.