stroke education q i initiative– bromenn healthcare october 2007
TRANSCRIPT
Stroke Education Q I Initiative–
BroMenn Healthcare
October 2007
BroMenn HealthcareNormal, Illinois
• BroMenn Regional Medical Center (BRMC)– 224 bed, full-service, teaching hospital – Level II trauma center with regional referral– Dedicated neuroscience unit– Inpatient rehabilitation
• Eureka Hospital (ECH)– 34 bed, critical access hospital
• Home Care & Hospice
Decision to Pursue Stroke Designation at BRMC
• To build on existing program strengths– Neuro, neurosurgical & neuro-
residency programs• Patient volume sufficient to
support a dedicated program– 200 strokes admitted annually– 100 TIAs admitted annually
Designation Objectives
• Promote a culture of interdisciplinary, patient-focused approach to stroke care across the care continuum
• Promote evidence-based practice• Maximize patient care outcomes• Continuous quality improvement
Collaborative Practice Team Was Formed
Neuroscience Care Unit
Intensive Care Unit
Other Nursing Unit Representation
Physical Medicine & Rehabilitation
Emergency Department
Case ManagementPharmacy, Lab &
Nutritional ServicesCardiopulmonary
Services
Emergency Medical System (EMS)
RadiologyPhysician
RepresentationAmerican Heart/
Stroke Association
Practice Team
• Establishes the program’s care delivery model, goals & improvement priorities
• Researches and implements best practices • Coordinates educational efforts• Monitors quality measure performance• Develops performance improvement plans• Includes interdisciplinary hospital,
medical staff and community representation
• Meets 4-6 times per year
Care Delivery Model Was Established
Patient experiences symptoms of
stroke
EMS is activated
Code Gray - Neurologist evaluation - NIHSS - Labs drawn - Imaging - TPA risk assessment
Location of the patient?
Is FAST Criteria met?
Nursing evaluationOutside
the Hospital
Within the
Hospital
Admission to ICU
TPA or Intervention?
Admission to NSCU
Ischemic Stroke/ TIA Care Map - Assessment guidelines - BP management - Swallow screen - Antithrombotics - Anticoagulation for afib - Lipid profiling - DVT prophylaxis - Patient education
Type of Stroke?
Admission to ICU
Evidence of hemorrhage
No evidence of hemorrhage
Yes
No
Neurosurgical evaluation and
additional imaging
Ischemic Stroke with Thrombolysis - Assessment guidelines - Bleeding precautions - BP management - Swallow screen - Antithrombotics - Anticoagulation for afib - Lipid profiling - DVT prophylaxis - Patient education
Intra-cerebral or sub-arachnoid hemorrhage
orders
Rehab evaluation
Discharge disposition determined - Rehabilitation - Skilled Care - Intermediate Care (Nursing Home Placement) - Home with Home Care - Home
Delivery of Stroke Care
Date: 12/05Rev: 09/06
Model developed from guidelines published by AHA, ASA and the Mayo Clinic.
Addresses screening performed in the community as well as the hospital
Includes diagnosis and care of ischemic and hemorrhagic strokes, and TIAs
The Model Encompasses
• FAST Screening• EMS protocols and education• Clinical practice guidelines to direct
patient care• Protocols for rapid diagnosis, BP
management, thrombolysis, education and prevention of complications
• Monitoring for early detection and response to problems
• Early establishment of rehabilitation plan
Benchmarking
Measure Q3 ‘04Q1 ’07(Januar
y)Target
IllinoisCaptur
e
DVT Prophylaxis 64% 100% 100% 75%
Antithrombotics at Discharge 89% 100% 100% 97%
Anticoagulation for A Fib 100% 100% 100% 93%
TPA Considered 67% 100% 100% 45%
Antithrombotics w/in 48 Hrs 89% 94% 100% 91%
Lipid Profile 33% 78% 90% 60%
Screen for Dysphagia 47% 56% 100% 47%
Stroke Education 14% 92% 90% 64%
Smoking Cessation 17% 100% 90% 84%
Plan for Rehab 70% 88% 90% 88%
Stroke Education
0%
20%
40%
60%
80%
100%
Q3-04 Q4-04 Q1-05 Q2-05 Q3-05 Q4-05 Q1-06 Q2-06 Q3-06 Q4-06 Q1-07
Work Group Meeting
Stroke Units
Marketing; Community Wellness
Leadership (QRM, Clin. ED)
Collaborative Culture
Stroke Binder
Let’s talk about Stroke
Progress
45%24%
14%0
20
40
60
80
100
3Q (2004) 4Q 1Q (2005) 2Q 3Q
Stroke Education
Stroke education workgroup
Development of patient education materials
Standardized Documentation
Measure
73%
14%
24%
71%
50%
0
20
40
60
80
100
3Q(2004)
4Q 1Q (2005)
2Q 3Q 4Q 1Q (2006)
Stroke Education
Standardized form for
documentation
More Staff
education
Ongoing Process
Measure
Plan
Act
CVA - TIA
• We do not use a separate CareMap for TIA patients.
• CVA patients were over the 90% mark, but TIA patients were not receiving the education.
Almost there
89%
14%
24%
71%
50%
0
20
40
60
80
100
3Q(2004)
4Q 1Q (2005)
2Q 3Q 4Q 1Q (2006)
2Q
Stroke EducationReinforcement to use with TIA
patients
Meditech Documentation
• Over the course of the last year on-line documentation had come full swing.
• We knew nurses were educating and the supply of notebooks correlated.
• Documentation needed to occur in the electronic realm.
Breaking the 90th !!
92%89%
14%
24%
71%
50%
0
20
40
60
80
100
3Q (2
004) 4Q
1Q (
2005)
2Q
3Q
4Q
1Q (2
006) 2Q
3Q 4Q
1Q (
2007)
Stroke Education
EMR documentation
developed
Holding the ground
Measure
Plan
Act
Questions
