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CS70
CLIK - Cincinnati Learning Is Quick
By: Susan Davis, Jo-Ann Burns, & Jennifer Williams; Barnes-Jewish Hospital, St. Louis, MO
For further information, please contact: sbd4906@bjc.org
Purpose: In an emergency department that triages an average of 275 patients a day, it was evident that a rapid process was needed to increase the triage nurse's ability to recognize potential stroke patients. The focus was the non-EMS patient, i.e., drive in or walk in type, where the triage nurse is the first to perform an assessment. If a patient's assessment was suggestive of a stroke, the triage nurse could quickly activate the stroke protocol process. This is important when the average ED wait is over 3 hours and there is only a 3 hour window to treat the ischemic stroke patient. The process for identifying potential strokes needed to be quick and simple to implement, as 102 nurses needed to be trained.
Intervention: Several standardized stroke assessment scales were evaluated for their ease to perform, time to assess, and ease of training. The National Institute of Health Stroke Scale (NIHSS) has multiple categories to score, 4 hours for training and if not used on a regular basis is time consuming and difficult to use. The Glasgow Coma Scale also has 3 categories, can take up to 2 hours for training, and has several weaknesses. The Cincinnati Stroke Scale (CSS) consists of 3 questions or tasks, is used extensively in the EMS community, takes 10-15 minutes to train and is easy to complete. It was decided to use the CSS based on the ease for implementation and training. The Emergency Department educators completed the training of 102 nurses.
Evaluation: All nurses were trained in a month and the assessment process was implemented. Any time a patient presents at the triage desk the patient is assessed for stroke. If any stroke symptomology is recognized the stroke protocol is activated since patients with any 1 of these 3 findings as a new event have a 72% probability of an ischemic stroke. Rapid recognition of an acute event can lead to early intervention for the ischemic stroke patient. The Cincinnati Stroke Scale has shown that learning is quick and gets results.Poster Presentation: Click on the icon below to launch
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