{"title":"捆绑方法提高住院患者卒中识别和治疗时间。","authors":"Lindy Drollinger, Marilyn A Prasun","doi":"10.1097/JNN.0000000000000685","DOIUrl":null,"url":null,"abstract":"<p><strong>Abstract: </strong>BACKGROUND: Early recognition of inpatient stroke is critical in reducing poor outcomes. A gap in knowledge and recognition of stroke by nursing staff was observed; protocols did not incorporate the Balance, Eyes, Face, Arms, Speech, and Time (BE-FAST) symptom mnemonic, and code stroke documentation was frequently incomplete. PURPOSE: This initiative aimed to improve timely recognition, evidence-based treatment, and nursing documentation of stroke-related symptoms. METHODS: This quality improvement initiative implemented an inpatient nurse-driven code stroke bundle. A pre-post prospective intervention design was implemented over 3 months. Code stroke bundle components included an evidence-based protocol, algorithm, visual aids, and education. Nursing communication and documentation used the BE-FAST mnemonic in a Situation, Background, Assessment, Recommendation format. RESULTS: Nursing stroke knowledge improved 8% (88% vs 96%, P < .001); stroke response times improved 15 minutes (25.9 vs 11 minutes, P = .383), although not significant; the code stroke documentation completion rate was increased 48.1% (0 [0%] vs 13 [48.1%], P < .001); and improved utilization of the BE-FAST tool with Situation, Background, Assessment, Recommendation communication (0 [0%] vs 20 [47.6%], P = < .001) was observed. The code stroke cancelation rate slightly worsened (10 [26.3%] vs 14 [26.9%], P = .949), code stroke notifications for altered mental status improved (15 [39.5%] vs 8 [15.7%], P = .015), and the stroke mimic rate improved (27 [71.1%] vs 35 [67.3%], P = .708). CONCLUSION: Nurses provide hospital patient care continuously and are in a key position to intervene when patients present changes in symptoms. Through education and creating an evidence-based protocol, nurses can impact patient outcomes in early recognition and activation of the code stroke system. Further studies are warranted to refine strategies leading to continued improvement in early stroke identification.</p>","PeriodicalId":50113,"journal":{"name":"Journal of Neuroscience Nursing","volume":"55 1","pages":"18-23"},"PeriodicalIF":1.5000,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bundled Approach to Improve Inpatient Stroke Recognition and Time to Treatment.\",\"authors\":\"Lindy Drollinger, Marilyn A Prasun\",\"doi\":\"10.1097/JNN.0000000000000685\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Abstract: </strong>BACKGROUND: Early recognition of inpatient stroke is critical in reducing poor outcomes. A gap in knowledge and recognition of stroke by nursing staff was observed; protocols did not incorporate the Balance, Eyes, Face, Arms, Speech, and Time (BE-FAST) symptom mnemonic, and code stroke documentation was frequently incomplete. PURPOSE: This initiative aimed to improve timely recognition, evidence-based treatment, and nursing documentation of stroke-related symptoms. METHODS: This quality improvement initiative implemented an inpatient nurse-driven code stroke bundle. A pre-post prospective intervention design was implemented over 3 months. Code stroke bundle components included an evidence-based protocol, algorithm, visual aids, and education. Nursing communication and documentation used the BE-FAST mnemonic in a Situation, Background, Assessment, Recommendation format. RESULTS: Nursing stroke knowledge improved 8% (88% vs 96%, P < .001); stroke response times improved 15 minutes (25.9 vs 11 minutes, P = .383), although not significant; the code stroke documentation completion rate was increased 48.1% (0 [0%] vs 13 [48.1%], P < .001); and improved utilization of the BE-FAST tool with Situation, Background, Assessment, Recommendation communication (0 [0%] vs 20 [47.6%], P = < .001) was observed. The code stroke cancelation rate slightly worsened (10 [26.3%] vs 14 [26.9%], P = .949), code stroke notifications for altered mental status improved (15 [39.5%] vs 8 [15.7%], P = .015), and the stroke mimic rate improved (27 [71.1%] vs 35 [67.3%], P = .708). CONCLUSION: Nurses provide hospital patient care continuously and are in a key position to intervene when patients present changes in symptoms. Through education and creating an evidence-based protocol, nurses can impact patient outcomes in early recognition and activation of the code stroke system. Further studies are warranted to refine strategies leading to continued improvement in early stroke identification.</p>\",\"PeriodicalId\":50113,\"journal\":{\"name\":\"Journal of Neuroscience Nursing\",\"volume\":\"55 1\",\"pages\":\"18-23\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2023-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuroscience Nursing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JNN.0000000000000685\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuroscience Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JNN.0000000000000685","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
摘要:背景:早期识别住院卒中患者是减少不良预后的关键。护理人员对脑卒中的认识和认知存在差距;协议没有纳入平衡、眼睛、面部、手臂、言语和时间(BE-FAST)症状助记符，而且代码笔划文档经常不完整。目的:本研究旨在提高卒中相关症状的及时识别、循证治疗和护理记录。方法:这项质量改进倡议实施了住院护士驱动的代码卒中包。前后前瞻性干预设计实施时间超过3个月。代码笔划包组件包括基于证据的协议、算法、可视化辅助工具和教育。护理沟通和文件使用BE-FAST助记符，格式为情景、背景、评估、建议。结果:护理卒中知识提高8% (88% vs 96%， P < 0.001);卒中反应时间改善了15分钟(25.9分钟vs 11分钟，P = 0.383)，但效果不显著;代码笔划文档完成率提高48.1% (0 [0%]vs 13 [48.1%]， P < .001);与情况、背景、评估、建议沟通的BE-FAST工具的利用率有所提高(0 [0%]vs 20 [47.6%]， P = < 0.001)。电码卒中取消率略有恶化(10 [26.3%]vs 14 [26.9%]， P = .949)，电码卒中通知精神状态改变改善(15 [39.5%]vs 8 [15.7%]， P = .015)，卒中模拟率改善(27 [71.1%]vs 35 [67.3%]， P = .708)。结论:护士持续提供医院患者护理，在患者出现症状变化时进行干预，处于关键地位。通过教育和创建基于证据的协议，护士可以在早期识别和激活代码中风系统方面影响患者的结果。需要进一步的研究来完善导致早期卒中识别持续改善的策略。
Bundled Approach to Improve Inpatient Stroke Recognition and Time to Treatment.
Abstract: BACKGROUND: Early recognition of inpatient stroke is critical in reducing poor outcomes. A gap in knowledge and recognition of stroke by nursing staff was observed; protocols did not incorporate the Balance, Eyes, Face, Arms, Speech, and Time (BE-FAST) symptom mnemonic, and code stroke documentation was frequently incomplete. PURPOSE: This initiative aimed to improve timely recognition, evidence-based treatment, and nursing documentation of stroke-related symptoms. METHODS: This quality improvement initiative implemented an inpatient nurse-driven code stroke bundle. A pre-post prospective intervention design was implemented over 3 months. Code stroke bundle components included an evidence-based protocol, algorithm, visual aids, and education. Nursing communication and documentation used the BE-FAST mnemonic in a Situation, Background, Assessment, Recommendation format. RESULTS: Nursing stroke knowledge improved 8% (88% vs 96%, P < .001); stroke response times improved 15 minutes (25.9 vs 11 minutes, P = .383), although not significant; the code stroke documentation completion rate was increased 48.1% (0 [0%] vs 13 [48.1%], P < .001); and improved utilization of the BE-FAST tool with Situation, Background, Assessment, Recommendation communication (0 [0%] vs 20 [47.6%], P = < .001) was observed. The code stroke cancelation rate slightly worsened (10 [26.3%] vs 14 [26.9%], P = .949), code stroke notifications for altered mental status improved (15 [39.5%] vs 8 [15.7%], P = .015), and the stroke mimic rate improved (27 [71.1%] vs 35 [67.3%], P = .708). CONCLUSION: Nurses provide hospital patient care continuously and are in a key position to intervene when patients present changes in symptoms. Through education and creating an evidence-based protocol, nurses can impact patient outcomes in early recognition and activation of the code stroke system. Further studies are warranted to refine strategies leading to continued improvement in early stroke identification.
期刊介绍：
The Journal of Neuroscience Nursing (JNN), the official journal of the American Association of Neuroscience Nurses, contains original articles on advances in neurosurgical and neurological techniques as they affect nursing care, theory and research, as well as commentary on the roles of the neuroscience nurse in the health care team.
The journal provides information to nurses and health care professionals working in diverse areas of neuroscience patient care such as multi-specialty and neuroscience intensive care units, general neuroscience units, combination units (neuro/ortho, neuromuscular/rehabilitation, neuropsychiatry, neurogerontology), rehabilitation units, medical-surgical units, pediatric units, emergency and trauma departments, and surgery. The information is applicable to professionals working in clinical, research, administrative, and educational settings.
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