A Stroke is a Stroke No Matter How Small A Stroke is a Stroke No Matter How Small Bleeds and Clots Risk Factors for All Bleeds and Clots Risk Factors for All Enhancing Patient Enhancing Patient Awareness through Staff Education and MentoringAwareness 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, PhD1University of Missouri School of Medicine and the 2University of Missouri Health Care

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 multi-disciplinary team continues to monitor and introduce interventional considerations to ultimately impact patient awareness and knowledge regarding stroke risks and prompt actions.

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

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

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.

CertificationCertification

AbstractAbstract EducationEducation StatisticsStatistics

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

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.