BEST PRACTICE
Early recognition and appropriate treatment of in patient stroke through the
implementation of protocols and a standardized process. Key success factor was
staff education.
Hospital:
Arnot Ogden Medical Center, Elmira, NY (Stroke module)
 256 beds (# stroke patients unknown by participant)
Key
Stakeholder
Overview:
Medical-Surgical Clinical Instructor
The Stroke Program of Care Committee at Arnot Ogden
realized that in-patient stroke victims were not receiving timely
care (immediate labs/CT, neurologist consults, etc). Care was
inconsistent and varied by nurse. Early/ongoing symptoms
were noted in the chart but alerts were not always
communicated to the appropriate professionals.
The goal was to establish a standardized process to facilitate
early recognition and treatment of in patient stroke.
The revised protocol relies on educating staff nurses to
recognize stroke symptoms and immediately initiate the inpatient protocol.
The effort has been well received by hospital staff and
attending physicians with immediate and sustained results.
Process/
Timeline:
3-4 months to implement:
 Developed stroke protocol specific to in-patients
o Led by her (educator) and NP who sees stroke
patients
o Several interdisciplinary contributors
o Ad-hoc committee of unit directors, nursing
educators and staff nurses.
 Approved by
o Stroke Medical Director
o Medical Executive committee chair
o Executive VP on stroke team
o Pharmacy and Therapeutics Committee
o Stroke program of Care Committee
Implementation:
In-patient stroke protocol binders were placed on every floor
 Communicated at staff meetings; positioned as high
priority, important news:
o Received immediate support from all. Positive
response from staff. They now have the clinical
information easily available with tools and
instruction. (stroke binders)
 Education was mandatory; no incentive other than
better outcomes for patients was given.
New protocol was communicated to labs/radiology
 Same priority of labs/CT as ED patients was
implemented
Education:
In-patient education module on intranet with quiz
 Mandatory for all in-patient nurses, and part of new
staff/nurse orientation
o Receive CEU credit
o 350 nurses trained hospital-wide
 Covers recognition and response
Reinforced education while on units
 Mock stroke codes for practice
Tools:
Bright pink stroke binder on every unit containing policy and:
 Checklists divided by role (unit clerk, clinical assistant,
nurse)
 Algorithms
 Physician orders
Laminated algorithms for inpatient protocol placed on each unit
 Simple, visual
Compliance
All charts are reviewed
Communication:
 Fallouts are provided to nurse manager who addresses
with responsible staff
Impact:
Results observed within one month; 3-4 months to truly positive
changes
 Nurses benefit from higher comfort/confidence level
 Timely recognition, time to labs/CT
 Increased compliance on measures as floor nurses
know what to do
 Enthusiastic compliance by staff, especially on the nonstroke units.
Non-neurologist physicians like that it
 Quickly puts effective therapy in place
Advice:
Obtain across the board buy-in, yet make it mandatory. Make
non-neurologist physicians aware of protocol
Provide easy to use/understand tools
 Simple and practical; quick check-lists
Ideally, provide face-to-face education
 Not always practical given the number of staff nurses
across various shifts