Abstract W P360: Challenges,Successes and Nurse Perceptions of Implementation of the NIH Stroke Scale on Multiple Units

Background: Joint Commission Comprehensive Stroke Certification (CSC) standards include the use of a standardized stroke scale across the organization. Physicians were utilizing the National Institutes of Health Stroke Scale (NIHSS)and it was identified that nurses had a poor understanding of how to perform and interpret the scale. Purpose: To use Plan-Do-Study-Act methodology to guide a quality improvement project to increase understanding and utilization of the NIHSS by nursing staff. This includes training and certifying all the nurses in stroke patient care units; followed by implementation into nursing practice. Methods: A multidisciplinary team was created to assess the current situation,develop education and implement plans based on best evidence. A literature search was completed. A course was developed by the stroke team to train and certify 250 nurses. Course content included lecture, discussion and accepted training video offered by the National Stroke Association. The intent of the course was to expand nursing knowledge and comfort with NIHSS. A pilot course was offered to the providers outside of these three key units and feedback was used to modify the course. Nurse perceptions of the NIHSS were examined prior to the training (n=211) and 2 months after implementation of the scale into routine practice (n=68). Adjustments and resources were developed and implemented based on results. Results: The course offered a first time certification pass rate 96% and nursing documentation compliance was 83% a month after implementation. However, in the first 3 months, 80% of those who completed the survey reported feeling they could accurately perform the NIHSS but almost 60% had only performed the scale 1-6 times. Many nurses expressed concern about the scale to being too subjective (55%) and too time consuming (50%). Conclusions: Even though the staff has been trained and certified to complete the scale, steps in the scale are consistently reported as difficult to assess. Low patient volume, infrequent use and patient barriers may contribute to challenges with NIHSS.