Background: Best practice guidelines recommend using standardized valid assessment tools to trend neurological assessment of acute stroke patients. The Oregon region and nationally recognized accrediting bodies for stroke certifications have identified Glasgow Coma Scale (GCS) as inadequate for quickly trending a patient’s neuro status after IV alteplase (t-PA) and/or thrombectomy.
Purpose: Develop a stroke neurological check that is quick to perform, more complete than a GCS, and provides a snapshot of patient status including original neuro symptoms.
Methods: Stroke program coordinator nurses and clinical experts from the Oregon region collaborated, conducted literature review, and developed a recommendation for a new standard stroke neuro check. The new stroke neuro check or SNAP (Stroke Neuro Assessment by Providence) entails 4 major parts: Level of consciousness as defined by NIH Stroke Scale (NIHSS) 1a, 1b, 1c or GCS; Pupil reactivity to light; movement of extremities as defined by NIHSS 5a, 5b, 6a, 6b, and finally trending patient’s original stroke symptoms. Throughout development of this standard stroke neuro check, we applied the Synergy Model combining stroke patient characteristics, health care environment, and nurse competencies. As a professional model of care, we incorporated the AACN Synergy Model to standardize RN education tools for implementation throughout ED, critical care, and stroke units.
Results: One certified comprehensive stroke center and three certified primary stroke centers implemented SNAP in various stages throughout their hospitals within a 9 month time period. Multiple education methods were used including, 1:1 staff education, laminated tip sheets, computer sticker reminders, safety huddles, staff meetings, stroke classes, SNAP pen lights, continuous quality improvement feedback aimed at improving nurse competency, and electronic medical record enhancements to harmonize environment of documentation with RN workflow.
Conclusion: The definition of a stroke neuro check continues to be controversial. Successful Oregon region development and implementation of SNAP through AACN Synergy Model, meets regulatory and practice requirements as a standard stroke neuro check.