Best Practice: Revised Process / Protocol
Best Practice: Revised Process / Protocol
The process of revising internal processes or protocols begins with the realization that a process doesn’t work well either in its delivery of care and/or use of resources. Following are some specific practices that were revised for the better, benefiting patients and staff.
Reallocation of Internal Resources for Improved Response to In-house Strokes. The vital role of planning and education
Hospital: / El Camino Hospital, Mountainview, CA (Stroke module)- 300 beds; 30 stroke/month
Key Stakeholder: / Stroke Program Coordinator
Overview: / Prior to implementing the revised process, ED nurses at El Camino would respond to in-hospital strokes while a Rapid Response (RR) nurse would go to the ED to cover for the missing ED nurse until her return. The process was perceived as “backward” and an inefficient use of resources.
The process was revised to rely on the RR nurse to assume leadership in response to in-hospital strokes, allowing the ED nurse to remain in the ED (but still available in the event that the RR nurse is not available).
The revised process works well and has generated greater satisfaction from all parties with how alerts are managed. Education efforts have paid off in that there are fewer inappropriate alerts, especially on night/weekend shifts.
- RR nurses are now considered part of the Stroke team; they are enthusiastic about their role despite greater responsibilities and time pressures.
- Additional RR nursing positions have been approved and hired in part by documenting the number of monthly alerts and time commitment.
- Implementing the revised process identified the need to educate floor nurses regarding when to initiate a stroke alert.
Process: / The process began by consulting the caregivers and then working its way up the chain:
- Initial consults were with RR nurses (enthusiastic) and RR managers (supportive)
- The proposed process was presented to the Medical Director
- Process and protocols were approved by Stroke Committee. This committee assisted in providing guidance in preparing and presenting the process and protocols to all required committees.
- Policy and Procedure committee to approve policy
- Medical Executive committee
- Forms committee to approve new forms to be used during actual stroke alert
Timeline: / Six months from start to roll out due to need to wait for committees’ scheduled meetings.
- Time was used to educate all involved
Implementation: / Implementation was a matter of communicating new process to relevant departments (ED) and extensive education efforts.
- ED nurse practice council alerted with email follow-up and physical letter in mailbox.
- Staff meetings and one-on-one time to ensure comfort level
Education: / All RR nurses and stroke unit nurses educated
- Online education module through Health Stream with quiz
- Mock alerts conducted
- Mock stroke alert board (how to recognize, respond) spends 2 weeks on each unit, after which all take a quiz and participate in a mock stroke alert (one per shift).
Tools: / Mock stroke alert board considered essential for educating floors
Stroke alert binder on each unit with paperwork, including:
- Flow sheet for patient information, responder information, etc. (simple, easy to fill in form; reviewed by Forms committee)
- Critique form; for internal use only and helpful to Program Coordinator so she can identify education needs
Impact: / Multiple hospital-wide benefits were observed:
- RR nurses more comfortable taking charge
- Stroke unit nurses also stronger in their role
- Greater satisfaction with how alerts are run (based on critique sheets)
- Fewer inappropriate alerts
- Easier to identify areas needing improvement (critique form)
Advice: / Obtain buy-in initially from RR team
- Evaluate resources of RR team so new responsibilities don’t overwhelm them
- Mock alerts and mock stroke board are invaluable tools