Abstract
Introduction: Traumatic brain injury (TBI) is a serious public health concern in the USA. Each year, TBIs contribute to a total of 52,000 deaths, accounting for 30% of all injury-related deaths and cases of permanent disability. Approximately 5 million survivors of TBI in the USA live with some form of disability [1]. Due to the severity of the brain injuries, some patients will experience a reduced level of consciousness. Early use of pharmacological treatment is fundamental to improve patient outcomes. Background: Providers presently seek guidelines to help them choose the right medication quickly and accurately. A pharmacological toolkit was designed to help providers in the neurology unit to enhance patientsâ level of consciousness and improve quality of care following a traumatic brain injury. The theoretical model for this project is the Havelock Theory of Change, which was used to guide the team during the stages of change. The Logic Model was used during the development and implementation of the toolkit. Methods: This project was developed and implemented in the medical neurological unit at the long term acute care and rehabilitation hospital. An educational program was initiated for providers to help them use the evidence based pharmacological toolkit to prescribe neuro-stimulates for patients with TBIs who demonstrated poor levels of consciousness. The Coma Recovery Scale -Revised (CRS-R) scale [2] was used to reassure if effectiveness of the neuropharmacology was feasible to treat poor alertness. The percentage of improvement on CRS-R score of 27.68%, with improvement of 3 points on CRS-R score, is a significant improvement to this QI project. The data was collected over six months and captured the variability reflecting improvement. A post implementation survey was answered by providers to track the benefit and practicability of the tool. Results: The level of satisfaction was high based on the survey response. Conclusion: Use of a neuropharmacological toolkit promises to help providers to treat severe traumatic brain injury in patients experiencing poor level of alertness. In conclusion, following the national brain injury organization recommendations, every institution needs to develop their own guideline to treat TBIs.
Highlights
Traumatic brain injury (TBI) is a serious public health concern in the USA
Traumatic brain injury (TBI) is a leading cause of disorders of consciousness (DOC), including coma, vegetative state (VS), and minimally conscious state (MCS). [3,4,5] these disorders are clearly distinct, the recovery of consciousness is recognized as occurring along a clinical continuum that covers a wide range of consciousness gradations, ranging from coma to the restoration of full consciousness
The tool that was developed and implemented was evidence-based and could have implications for other comparable sites. This QI project demonstrated that the evidence-based pharmacological toolkit is a promising resource to help providers to treat lack of alertness when treating patients experiencing poor recovery after severe TBIs [9]
Summary
Traumatic brain injury (TBI) is a serious public health concern in the USA. Each year, TBIs contribute to a total of 52,000 deaths, accounting for 30% of all injury-related deaths and cases of permanent disability. A pharmacological toolkit was designed to help providers in the neurology unit to enhance patients’ level of consciousness and improve quality of care following a traumatic brain injury. An educational program was initiated for providers to help them use the evidence based pharmacological toolkit to prescribe neuro-stimulates for patients with TBIs who demonstrated poor levels of consciousness. Conclusion: Use of a neuropharmacological toolkit promises to help providers to treat severe traumatic brain injury in patients experiencing poor level of alertness. The development of a pharmacological toolkit (See Appendix: Figure 1: Pharmacological Toolkit (See all references about all medications listed used at this Neuro Unit.) is essential to help providers to prescribe medications that optimize patient prognosis and improve efficacy of treatment to enhance consciousness [6]. Most of the medical neuro units’ beds are occupied by adult patients greater than eighteen years of age with severe traumatic brain injuries, and they are classified as disorders of consciousness.
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