Transcript Sickle Cell Quality Improvement Project

A Stroke is a Stroke No Matter How Small  Bleeds and Clots Risk Factors for All  Enhancing Patient
Awareness through Staff Education and Mentoring
Margaret Leigh Kite, RN, MSN, CNL, Niranjan N. Singh1, MD, Pradeep Sahota1, MD, FAAN, FAES, FAASM, Karen R. Cox2, RN, PhD
1University of Missouri School of Medicine and the 2University of Missouri Health Care
Abstract
Background: Every 40 seconds, someone in the United States
suffers a stroke, contributing to more than 800,000 cases
annually. Stroke is the third leading cause of death; however,
80% of strokes are preventable. By the time you read this
abstract, approximately six people will have suffered a stroke. Of
these patients, education is a true problem.
University of Missouri Health Care (MUHC) is an
academic medical center with a primary service area of 25
counties in Mid-Missouri. MUHC is a Joint Commission
recognized Advanced Primary Stroke Center and can provide the
most up-to-date comprehensive stroke treatment. Part of the
Missouri Stroke Program mission is to provide staff education in
order to provide detailed education to our patients.
Purpose of Study: To provide education to the nursing staff,
particularly those specifically taking care of stroke patients and
families, so they could educate the patient more effectively.
Methods: In order to meet required measures for The Joint
Commission (TJC) stroke center designation, patient education
must be provided in 80% of cases. Random charts of patient
discharged with Ischemic/ Hemorrhagic strokes, prior to the start
of the certification process, were audited for the required stroke
education to include the following:
•
Signs and symptoms of stroke
•
Risk factors associated with stroke
•
How and when to contact 9-1-1
•
Medication education/compliance and follow up
information
Data was traced starting in September 2009. Baseline education
compliance was 75% (n=124). As we continued to examine this,
we found that nursing staff was not educating the patients on a
regular basis. Reasons included:
•
Lack of time
•
Unsure of knowledge to be taught
•
Lack of proper documentation
•
Patient/ family not really interested in material.
From this information, a multi-pronged approach to address the
issues was developed which identified the following:
•
One-on-one teaching sessions with personnel caring for
stroke patients.
•
Developed a stroke patient teaching record (PTR) that
held all available education for patients plus a space for a
narrative
•
A stroke educational folder was created and included all
information pertaining to stroke
Results: After implementation of a comprehensive staff
education effort, The Missouri Stroke Program saw an increase
in patient education compliance. The average compliance for
2010 has increased to 84% (n= 163) and continues to improve.
Using a Plan-Do-Study-Act (PDSA) model, MUHC’s multidisciplinary team continues to monitor and introduce
interventional considerations to ultimately impact patient
awareness and knowledge regarding stroke risks and prompt
actions.
Education
Preventing death due to strokes requires delivery of comprehensive,
multidisciplinary, patient centered clinical care that supports
neurosciences education and research. With some 800,000 cases of
stroke annually, educating all members of the clinical team, from
managing acute symptoms through pre and post-discharge self-care
teaching is essential for success.
1. Patient and Family/Caretaker
Comprehensive Education Packet/Core Measures
• Activation of EMS
• Follow-up after discharge
• Medications at discharge
• Risk factors for stroke
• Warning signs and symptoms
2. Public and Community Awareness
• Stroke Awareness Fair
• Public Radio and TV
• Heart Walk
• Community Outreach
Statistics
Documentation of pre-discharge patient education should encompass
5 areas : a) stroke risk factors, b) stroke warning signs and symptoms;
c) how and when to contact 9-1-1; d) follow-up plans; and e)
medication management. Reliable documentation of all 5 areas has
increased but is not yet perfect.
Since the program started, over 400 patients with ischemic and
hemorrhagic strokes have been treated at MUHC. Six percent (n=23)
have been treated with rt-PA. 100% of these received the infusion
within 30 minutes of arrival.
3. Professional Training
• ER and In-Patient Protocol Education
• rt-PA Education
• Comprehensive Stroke Education Online Program
• ER and In-Patient Stroke Mock Codes
• Neurology/Neurosurgery Grand rounds
• Unit Based Patient Teaching Record Education
Certification
The Missouri Stroke Program earned the Gold Seal of Approval
from The Joint Commission for Primary Stroke Centers on August
13, 2010.
Time Lost is Brain Lost