Audit

Patient Demographics

Patient MRN:

Patient age:

Date and time of admission to the NCCU:
Date and time of arrival to the ED (if applicable):
ED Encounter/ Neurology Consult Information

Is the Neurology Consult or Stroke Service Note present?

Is the date and time of last known well documented?

Is the date and time of symptom onset documented?

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)

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

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

Were labs ordered, drawn and resulted within 45 mins?

NCCU Admission

Is there an admission note documented on arrival to the NCCU?

(Are stroke order sets used for patients admitted to the NCCU?) Can the nurse speak to customization of NCCU admission order sets and show the order set in Sunrise?

What is this patient's diagnosis?

Is NIHSS documented on arrival?

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

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

Are Post-IV tPA vital signs and neuro checks documented q 15mins x 2hrs, q 30mins x 6hrs and q 1hr x16 hrs?

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

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

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

Is an antithrombotic medication given by day 2?

Is an antithrombotic prescribed at discharge?

Is a lipid lowering medication ordered at discharge?

Is the patient on VTE prophylaxis?

Can the nurse describe the signs and symptoms of SAH?

Is there a documented Hunt and Hess score for SAH patients?

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

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

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

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

Was nimodipine ordered and given within 24 hours of arrival?

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

Is there a documented ICH score for intracerebral hemorrhage patients?

Is GCS documented?

If coag reversal is indicated, was it done?

Is the patient on VTE prophylaxis?

Plan of Care

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

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)

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

Patient Education

Is the patient's readiness to learn documented daily?

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)

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

Has stroke education been initiated on this patient?

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

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

Diagnostic/ Invasive Procedures and Treatments (tPA)

Is the nurse able to verbalize the process for communicating critical lab results?

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

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? (See policy GEN013)

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

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

NCCU Nurse Education

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

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

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

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

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

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

Is the nurse able to verbalize having had education on SAH treatment, management of IVC devices, management of vasospasm, vasoactive drugs, and intracranial dynamic monitoring?

Is the nurse able to locate the protocol for intracranial dynamic monitoring?

Is the nurse able to locate the hypothermia protocol for stroke patients?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.