Beyond F.A.S.T: A Screening Tool to Improve Identification and Treatment of Stroke

2.50
Hdl Handle:
http://hdl.handle.net/10755/344145
Category:
Abstract
Type:
Poster
Title:
Beyond F.A.S.T: A Screening Tool to Improve Identification and Treatment of Stroke
Author(s):
Brennan, Denise; Robin, Nancy; Gomes McGillivray, Celia
Lead Author STTI Affiliation:
Non-member
Author Details:
Denise Brennan, MSN, RN, CNL, dbrennan@lifespan.org; Nancy Robin, M.Ed., RN, CEN; Celia Gomes McGillivray, MPH, MSN, RN-BC, CHES
Abstract:
Purpose: Stroke is a leading cause of disability, cognitive impairment and death in the United States. Emergency Department (ED) triage nurses are trained to recognize signs and symptoms of stroke, but cerebellar infarcts and atypical presentations were not being identified early. The objective of this project was to utilize strategies to identify early in the triage process, atypical signs and symptoms of a stroke and decrease the number of stroke outliers. Design: Quality Improvement Project. Setting: Teaching 60,000 visits, urban community hospital. Participants/Subjects: All ED RN’s, Nurse Educator, ED Director, Assistant Clinical Managers, ED physicians. Methods: Cerebellar infarcts can be missed or delayed in patients presenting to the emergency department. Patients who have sustained such injury may present with vertigo, visual changes, fall or altered mental status. These presentations can mimic benign conditions and can be missed by ED nurses and physicians. In order to better identify atypical presentations as a potential stroke, a strategy involving the implementation of a screening tool in the electronic medical record was developed collaboratively by ED physicians and nurses. If a patient presents with a complaint of typical or atypical signs, a stroke screening tool would appear. This screening is a required field triggered by specific presentations that is completed by the triage nurse but also viewed by physicians. The stroke screening tool helps the nurse to assess signs and symptoms seen in the outlier cases. It also acts as a prompt to focus assessment information necessary for a potential stroke intervention candidate. Results/Outcomes: This project began in February of 2012. Prior to the implementation of this screening tool, the concurrent review of stroke cases identified trends where care was delayed or the stroke was not identified in the emergency department. By developing the electronic record to flag patients with these typical and atypical presentations for screening, the outlier cases have been reduced and improvement has been seen in various stroke metrics. The implementation of the stroke screening tool has reduced the number of outlier cases, improved recognition of the atypical presentation of stroke patients, thrombolytic administration time, door to CT time and the number of t-PA cases. Nurses are prompted to discuss with the physician the possibility of atypical stroke presentation. This collaboration has been successful. Physicians too are aware how atypical stroke presentations may be missed. Many patients present to the ED with benign conditions that can be further assessed and stroke can be ruled out. In a busy emergency department, it is easy to attribute atypical signs and symptoms of a stroke to benign conditions. Having a electronic prompt constantly raises awareness. Implications: There is more work to be done in the early identification of stroke patients. Emergency departments need to develop collaborative strategies that will assist them in the early identification of stroke patients. Developing a screening tool in the electronic medical record can be a valuable defense in identifying potential atypical presentations.
Keywords:
Stroke; Improve Stroke Identification
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleBeyond F.A.S.T: A Screening Tool to Improve Identification and Treatment of Strokeen_GB
dc.contributor.authorBrennan, Deniseen_GB
dc.contributor.authorRobin, Nancyen_GB
dc.contributor.authorGomes McGillivray, Celiaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsDenise Brennan, MSN, RN, CNL, dbrennan@lifespan.org; Nancy Robin, M.Ed., RN, CEN; Celia Gomes McGillivray, MPH, MSN, RN-BC, CHESen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344145-
dc.description.abstractPurpose: Stroke is a leading cause of disability, cognitive impairment and death in the United States. Emergency Department (ED) triage nurses are trained to recognize signs and symptoms of stroke, but cerebellar infarcts and atypical presentations were not being identified early. The objective of this project was to utilize strategies to identify early in the triage process, atypical signs and symptoms of a stroke and decrease the number of stroke outliers. Design: Quality Improvement Project. Setting: Teaching 60,000 visits, urban community hospital. Participants/Subjects: All ED RN’s, Nurse Educator, ED Director, Assistant Clinical Managers, ED physicians. Methods: Cerebellar infarcts can be missed or delayed in patients presenting to the emergency department. Patients who have sustained such injury may present with vertigo, visual changes, fall or altered mental status. These presentations can mimic benign conditions and can be missed by ED nurses and physicians. In order to better identify atypical presentations as a potential stroke, a strategy involving the implementation of a screening tool in the electronic medical record was developed collaboratively by ED physicians and nurses. If a patient presents with a complaint of typical or atypical signs, a stroke screening tool would appear. This screening is a required field triggered by specific presentations that is completed by the triage nurse but also viewed by physicians. The stroke screening tool helps the nurse to assess signs and symptoms seen in the outlier cases. It also acts as a prompt to focus assessment information necessary for a potential stroke intervention candidate. Results/Outcomes: This project began in February of 2012. Prior to the implementation of this screening tool, the concurrent review of stroke cases identified trends where care was delayed or the stroke was not identified in the emergency department. By developing the electronic record to flag patients with these typical and atypical presentations for screening, the outlier cases have been reduced and improvement has been seen in various stroke metrics. The implementation of the stroke screening tool has reduced the number of outlier cases, improved recognition of the atypical presentation of stroke patients, thrombolytic administration time, door to CT time and the number of t-PA cases. Nurses are prompted to discuss with the physician the possibility of atypical stroke presentation. This collaboration has been successful. Physicians too are aware how atypical stroke presentations may be missed. Many patients present to the ED with benign conditions that can be further assessed and stroke can be ruled out. In a busy emergency department, it is easy to attribute atypical signs and symptoms of a stroke to benign conditions. Having a electronic prompt constantly raises awareness. Implications: There is more work to be done in the early identification of stroke patients. Emergency departments need to develop collaborative strategies that will assist them in the early identification of stroke patients. Developing a screening tool in the electronic medical record can be a valuable defense in identifying potential atypical presentations.en_GB
dc.subjectStrokeen_GB
dc.subjectImprove Stroke Identificationen_GB
dc.date.available2015-02-04T11:27:17Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:17Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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