BRU Comprehensive Stroke Certification Preparation Tracer

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Patient Demographics

• Patient MRN:

• Patient age:

• Date and time of admission to the BRU:

• Date and time of admission to the ED (if applicable):

ED Encounter/ Neurology Consult Information

• Is the Neurology Consult or Stroke Service Note present?

  Yes

  No

  N/A

• Is the date and time of last known well documented?

  Yes

  No

  N/A

• Is the date and time of symptom onset documented?

  Yes

  No

  N/A

• Is there documentation of mode of arrival to the hospital/ ED? (May be in EDMS tab if pt arrived through the ED or in the paper chart.)

  Yes

  No

  N/A

• Is the nurse able to speak to how hand-off of care is communicated between the ED and BRU?

  Yes

  No

  N/A

• If the patient was ordered a CT in the ED, was it obtained and resulted within 45 mins?

  Yes

  No

  N/A

• Were labs ordered, drawn and resulted within 45 mins?

  Yes

  No

  N/A

BRU Admission

• Is there an admission note documented on arrival to the BRU?

  Yes

  No

  N/A

• Was a stroke order set used to place orders on this patient?

  Yes

  No

  N/A

• What is this patient's diagnosis?

  ischemic

  hemorrhagic

• Is the NIHSS documented on arrival?

  Yes

  No

  N/A

• Was a swallow screen completed prior to first PO intake? (Include date and time of screen and first PO.)

  Yes

  No

  N/A

• Is the nurse able to verbalize what happens if the patient fails the swallow screen?

  Yes

  No

  N/A

• Is the nurse able to verbalize that SLP is available on weekends?

  Yes

  No

  N/A

• Was an antithrombotic medication given by day 2?

  Yes

  No

  N/A

• Was an antithrombotic prescribed at discharge?

  Yes

  No

  N/A

• Was a lipid lowering medication ordered at discharge?

  Yes

  No

  N/A

• Is the patient on VTE prophylaxis?

  Yes

  No

  N/A

• If the patient was an IV tPA candidate, did they receive IV tPA at this hospital or OSH prior to arrival?

  Yes

  No

  N/A

• What is the date and time the IV tPA was started?

  Date

• Is this patient in the OPTIMIST trial?

  Yes

  No

  N/A

• Are the post-IV tPA vital signs and neuro checks documented q 15 mins x 2 hrs, q 30 mins x 6 hrs, and q 1 hr x 16 hrs?

  Yes

  No

  N/A

• Are vital signs and neuro checks documented per the OPTIMIST trial protocol frequency?

  Yes

  No

  N/A

• Can the nurse describe the signs and symptoms of SAH?

  Yes

  No

  N/A

• Is there documented Hunt and Hess score for the SAH patients?

  Yes

  No

  N/A

• Can the nurse explain the Hunt and Hess scale for SAH patients?

  Yes

  No

  N/A

• Was a swallow screen completed prior to first PO? (Include date and time of screen and first PO.)

  Yes

  No

  N/A

• Is the nurse able to verbalize what happens if the patient fails the swallow screen?

  Yes

  No

  N/A

• Is the nurse able to verbalize that SLP is available on weekends?

  Yes

  No

  N/A

• Was nimodipine ordered and given within 24 hours of arrival?

  Yes

  No

  N/A

• Is there documentation explaining why nimodipine was not given within 24 hours?

  Yes

  No

  N/A

• Is there a documented ICH score for intracerebral hemorrhage patients?

  Yes

  No

  N/A

• Is GCS documented?

  Yes

  No

  N/A

• If coag reversal is indicated, was it done?

  Yes

  No

  N/A

• Is the patient on VTE prophylaxis?

  Yes

  No

  N/A

• Is the nurse able to verbalize what screenings are done on patients in the BRU? (SBT, PHQ9, Swallow Screen)

  Yes

  No

  N/A

• Is the nurse able to verbalize the appropriate follow up if the patient screens positive for depression (score >/= 9 on the PHQ9)? The provider should evaluate the patient and determine if a psych consult or anti-depressants are warranted.

  Yes

  No

  N/A

Plan of Care

• Is the plan of care documented? (Review Daily Goals Flowsheet)

  Yes

  No

  N/A

• Is the nurse able to verbalize and show in the EMR how the multidisciplinary plan of care is documented? (PT/ OT/ SLP/ Case Management/ PESS/ Provider)

  Yes

  No

  N/A

• Is the nurse able to verbalize how the patient and/ or family is involved in the plan of care?

  Yes

  No

  N/A

Patient Education

• Is the patient's readiness to learn documented daily?

  Yes

  No

  N/A

• Is the nurse able to verbalize and show in the EMR how education is done when the patient is unable to learn? (Educate the family.)

  Yes

  No

  N/A

• Is the nurse able to state the patient's PMH and identify any personal risk factors for stroke?

  Yes

  No

  N/A

• Has stroke education been initiated on this patient?

  Yes

  No

  N/A

• Have any of the 5 required elements of stroke education been addressed thus far?

  Select activation of EMS medications f/u after discharge warning signs personal risk factors for stroke

  • activation of EMS
  • medications
  • f/u after discharge
  • warning signs
  • personal risk factors for stroke

• Is the nurse able to verbalize the symptoms of SAH for the purposes of patient education?

  Yes

  No

  N/A

Diagnostic/ Invasive Procedures and Treatments (tPA)

• Is the nurse able to verbalize the process for communication critical lab results? (BRU RNs only take CAV on RN managed heparin gtts, all other lab values should be communicated directly to provider)

  Yes

  No

  N/A

• If the patient has had a diagnostic or invasive procedure that requires consent, is a completed consent present?

  Yes

  No

  N/A

• If the patient has had a cerebrovascular angiogram with or without intervention, are the required frequent vital signs, site, neurovascular and neuro checks present in the EMR? (policy GEN013)

  Yes

  No

  N/A

• If the patient has received IV tPA, are the required frequent vital signs and neurochecks present in the EMR? (policy BAT002)

  Yes

  No

  N/A

• If the patient has received IA tPA or other endovascular recanalization therapy, are the required frequent vital signs and neurochecks present in the EMR?

  Yes

  No

  N/A

BRU Nurse Education

• Does the nurse know whether we are a Primary or Comprehensive Stroke Center?

  Yes

  No

  N/A

• Is the nurse able to discuss familiarity with the CSC core measures?

  Yes

  No

  N/A

• Is the nurse able to verbalize how feedback on the measures is provided to the unit?

  Yes

  No

  N/A

• Is the nurse able to speak to the clinical practice guidelines?

  Yes

  No

  N/A

• Is the nurse able to name 2 National Patient Safety Goals?

  Yes

  No

  N/A

• Is the nurse able to verbalize the number of stroke education hours required annually? (8hrs)

  Yes

  No

  N/A

• Is the nurse able to verbalize how the 8 hours are obtained?

  Yes

  No

  N/A

• Is the nurse able to verbalize stroke specific competencies completed in orientation?

  Yes

  No

  N/A

• Is the nurse able to verbalize the additional stroke education provided during orientation to work in the BRU?

  Yes

  No

  N/A