Wasilowsky, Bonnie, BSPA-HCA, RN, CNRN

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingMaking a Checklist and Checking it Twice:Implementing a Strategy to Meet Stroke CenterMonitoring Guidelines.Bonnie Wasilowsky BSPA-HCA, RN, CNRNLehigh Valley Health Network, Bonnie.Wasilowsky@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtWasilowsky, B. (2017, March). Making a Checklist and Checking it Twice: Implementing a Strategy to Meet Stroke Center MonitoringGuidelines. Poster Presented at: American Association of Neuroscience Nurses 49th Annual Educational Meeting (AANN), Boston,MA.   ABSTRACT EVALUATION RESULTS© 2017 Lehigh Valley Health NetworkReferences:1.  American Heart Association and American Stroke Association. (2013). Get with the Guidelines performance achievement. Retrieved April 12, 2016 from www.heart.org/HEARTORG/HealthcareProfessional/GetWithTheGuidelines.2.  Jauch, E., Saver, J., Adams, H., Bruno, A., et al. (2013). Guidelines for the early management of patients with ischemic stroke. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 44, 870-947.3.  Powers, W., Derdeyn, C., Biller, J., Coffey, C., et al (2015).  AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment. Stroke, published online before print June 29 2015. Retrieved April 16, 2016 from: www.stroke.ahajournals.org. The sudden, devastating injury of ischemic stroke requires emergent decision making to administer recombinant tissue plasminogen activator (rtPA). Once the decision is made, the clock for clinical nurses accelerates. Vital signs and neurological status are monitored at scheduled intervals. Staff within the LVHN neuroscience intensive care unit (NSICU) implemented a process which includes a checklist for mapping out the times of monitoring parameters. Leadership team members review in real time as a second pair of eyes, verifying documentation compliance. Clinical nurses care for the complex stroke patient confident that charting is audited for completeness. Compared to pre-implementation of the check-list and double checks, post-implementation compliance with the American Stroke Association guidelines for patient monitoring was improved. This poster reviews the guidelines for caring and monitoring ischemic stroke patients and details a care strategy which achieves both the patient’s needs and regulatory requirements. Page sent to Management Team when ptient arrives on unitManagement team member reviews real-time documentation          and provides feedback Spreadsheet developed for record-keeping and analysis purposes   INTRODUCTIONOpportunities existed to improve documentation of assessment and care delivery associated with American Stroke Association guidelines for monitoring patients who have received rtPA post ischemic stroke.   METHODSAmerican Stroke Association Recommendations for Monitoring Patients Who Have Received rtPA•  Get with the Guidelines (GWTG) Stroke   − Includes patient management and data collection tool•  Specialized Stroke Units   −  Recommend initial and ongoing stroke-specific education requirements for clinical staff•  Standard Order Sets   −  Outline vital sign and neurological exam monitoring   −  Identifies target heart rate & blood pressure•  Patient Monitoring Parameters > Hemodynamic vital signs monitored and documented   −  q 15 minutes during infusion, then   −  q 15 minutes  x 1 hour after infusion, then    −  q 30 minutes x 6 hours, then   −  q hour x 16 hours  > Neurological examination monitored and documented   −  q 15 minutes during infusion, then   −  q 30 minutes x 6 hours, then   −  q hour x 16 hours  > Peripheral Vascular Assessment   −  q 15 minutes x 1 hour, then   −  q 30 minutes x 2 hours   −  q 60 minutes x 5 hours   OBJECTIVES •  Review the American Stroke Association guidelines for monitoring patients who have received rtPA. •  Detail the documentation checklist utilized to map out times of required actions and associated documentation. •  Gain knowledge of outcome data related to compliance with regulatory and institutional documentation requirements.Reperfusion ChecksheetReperfusion Checksheet  Patient Initials ________       MR# __________    Admit Date ______     Management Notified ___________  IV TPA  TPA Start Time __________________  IR Intervention including IV/IA TPA, IA TPA, Mechanical Intervention  -- All Cases  Time Patient on Unit ____________________   Neuro Check, HR, BP, RR VALIDATED every 15 minutes for 2 hours from IV TPA start time    THEN Neuro Check, HR, BP, RR VALIDATED every 30 minutes for the next 6 hours (Hour 3-8)    THEN Neuro Check, HR, BP, RR VALIDATED Every hour   Interventional Radiology Patients --- Groin Check including Pulse, Color, Temperature and Sensation  -- Checks begin when patient reaches the unit   Time Patient Arrived on Unit ________________________________  Groin Check Validated        Every 15 Minutes for 4 checks Every 30 Minutes X 4 checks Every 60 Minutes X 5 hours or until Sheath removed   Not a Permanent Part of Patient Chart                                                                                                          1 2 3 4 5 6   6 7 8 9 10 11 12 13 14 15 16 Time                 Q15                  Time                 Q30                 Time                 Q1h                  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Time                 Q15                  Time                 Q30                 Time                 Q1h                 Disclosure Statement: There are no relevant conflicts of interests to diclose.Stroke Audit ProcessCONCLUSIONS •  Checklist eases complex timing of assessments. •  Checklist increased staff accountability for documentation.  •  Real-time monitoring and data transparency improves documentation compliance.Making a Checklist and Checking it Twice:Implementing a Strategy to Meet Stroke Center Monitoring GuidelinesBonnie Wasilowsky, BSN, BSPA, RN, CNRNLehigh Valley Health Network, Allentown, PennsylvaniaMagnetTM Since2002

Making a Checklist and Checking it Twice: Implementing a Strategy to Meet Stroke Center Monitoring Guidelines.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1811&context=patient-care-services-nursing

Making a Checklist and Checking it Twice: Implementing a Strategy to Meet Stroke Center Monitoring Guidelines.

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