Purpose: Nurse led patient education programs to improve patient understanding of the signs and symptoms (s/s) of a stroke and their personal stroke risk factors can play a significant role in preventing secondary stroke. No such initiatives could be found for an urban academic medical center in the United States when conducting a literature search, despite a Healthy People 2020 edict to address stroke awareness in adults. The goal of this project was to improve patient understanding of s/s of stroke as well as personal risk factors, and to ensure smooth patient transitions to the community. Method: A tool was developed for charge nurses to use when providing education to patients. The tool included patient demographic information and patient specific stroke risk factors. The previously used script for phone calls included signs and symptoms but was modified to include personal risk factors and corresponding behavior modification. All patients, discharged to home with a diagnosis of stroke or transient ischemic attack (TIA), were called within two weeks of discharge per the Joint Commission Comprehensive Stroke Center recommendation. Two attempts were made to reach each patient and a detailed log was maintained to track patient’s response to questions. Results: In the two months prior to the project being initiated, there were 37 patients reached via phone who had been discharged home from the stroke unit with a diagnoses of stroke or TIA. Of the 37 called, there were 5 who were unaware of the s/s of a stroke. For the two months since beginning the intervention, 42 successful calls were made to patients discharged home. Of these 42, only 2 patients did not know the s/s of stroke or their personal risk factors (p value: 0.16). Conclusions: This project allowed for a new approach to patient focused, nurse led education to improve patient understanding of the s/s of a stroke and individual risk factors. There was a ten percent improvement in the number of patients with an understanding of the s/s of a stroke. An encouraging outcome from this project was an improvement in RN Communication scores on patient’s HCAHPS surveys in the two months since starting the intervention.
Intro: In 2015, a 21-bed acute stroke unit within a Comprehensive Stroke Center at an academic medical facility experienced a stark increase in their falls rate. A monthly average of 4.58 falls per 1,000 patient days was recorded for 2015, which was an increase over the two previous years. Methods: Various options were discussed to address the high rate of falls based on the unit population and the types of falls. After discovering an increase in falls from the bedside chair it was decided to implement use of a self-releasing safety belt when the patients were out of bed to the chair. The belts incorporated an alarm tied into the call bell system that would be triggered when released. This allowed for an additional layer of alarm to elicit a staff response to the room prior to a patient falling. Nursing and therapy staffs were educated on the utilization of these self-releasing belts when assisting any patient from bed to chair. Every patient admitted with the diagnosis of stroke utilized these belts while out of bed to the chair, even those who were deemed fully independent. Results: After implementation, the average fall per 1,000 patient days’ rate decreased from 4.58 falls to 3.89 falls per month. The total numbers of falls also decreased from 28 in 2015 to 20 in 2016. Falls from the chair, specifically, decreased from 11 in 2015 to 5 in 2016, representing a fifty percent decrease in falls from the chair with use of the self-releasing seatbelt. Conclusions: Overall, the falls rate decreased, and the falls specifically from the chair decreased. Data collected reflects all falls on the unit during the period in question and was not limited to patients using the self-releasing safety belts or falls from the chair. The next steps will be to ensure this practice is utilized uniformly and to evaluate similar methods to reduce falls from the bed and drive our rates down to zero falls per month.
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