Abstract WP360: Utilization of the National Institutes of Health Stroke Scale: Challenges and Interventions

Abstract

Background and Issues The National Institutes of Health Stroke Scale (NIHSS) is a valuable tool that assists in the diagnosis and treatment path of stroke patients. In addition, the NIHSS can provide an objective measurement of the patient’s neurological status and progress throughout the acute care hospitalization. Even though the tool’s validity, impact on patient care, and usefulness in post discharge disposition decision-making is well known, it is not used as a standard tool in every institution that treats stroke patients. Purpose A survey was developed to gather information about the administration of the NIHSS in order to ascertain its usage rate and any perceived barriers would deter its usage. Based on the results, a plan was developed for to assist in overcoming the barriers and for providing more effective usage of the NIHSS. Methods An NIHSS Utilization Survey was sent to hospitals across the country. Fifteen questions queried educational practices, competence, usage rate, challenges, and effectiveness related to the NISHH. The results from 194 respondents were compiled an analyzed. Results The results showed that the main use for the NIHSS was to determine eligibility to receive t-PA; very few used it for developing plans for patient care beyond t-PA eligibility. A few of the barriers identified in the application of the NIHSS included time required to perform the exam, inconsistent scoring among examiners, especially with comatose or uncooperative patients, and lack of adequate teaching resources for educating examiners regarding how to use the scale. Conclusion Many institutions face the similar issues regarding the usage of and performance in administering the NIHSS. A continued focus on addressing these issues, including methods for modifying NIHSS education practices and assuring competency and inter-rater reliability, is needed to effectively enhance NIHSS accuracy and incorporation into patient care treatment plans for achieving optimal outcomes.