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Published on: January 15, 2017
Improving stroke education performance measures scores: the impact of a stroke nurse coordinator
Josephine Malfitano1, Barbara S Turner, Ed Piper
1Questions or comments about this article may be directed to Josephine Malfitano, DNP MBA RN FNP CPHQ NE-BC, at jo.malfitano@onslow.org. She is the Performance Improvement & Accreditation Manager, Onslow Memorial Hospital, Jacksonville, NC. Barbara S. Turner, PhD RN FAAN, is the Elisabeth P. Hanes Distinguished Professor and Director of the Doctor of Nursing Practice Program at Duke University School of Nursing, Durham NC. Ed Piper, PhD FACHE, is the President and CEO of Onslow Memorial Hospital, Jacksonville, NC. Penney A. Burlingame, DHA RN FACHE, is the Senior Vice President of Nursing and Clinical Services of Onslow Memorial Hospital, Jacksonville, NC. Elizabeth D'Angelo, MD, is a Radiologist and Chief of Staff at Onslow Memorial Hospital, Jacksonville, NC.
Background:
Stroke is a leading cause of death and adult disability worldwide. North Carolina is considered to be a part of an area of the United States called the "stroke belt." Education coupled with implementation of a program that promotes primary and secondary stroke prevention is paramount to support the reduction of stroke and improvement of stroke care across the continuum. The groundwork for stroke care at Onslow Memorial Hospital began in 2006 with participation in the North Carolina Stroke Care Collaborative (NCSCC), which allowed for benchmarking of data.
Methods:
A pretest and posttest design was used to evaluate the effectiveness of a dedicated stroke nurse coordinator on stroke education performance measure scores. Compliance with stroke education performance measures is met when documentation reflects education provided or material given during the hospital stay. Three hundred sixty-seven charts submitted to the NCSCC from Onslow Memorial Hospital were reviewed. Data collected were entered into the NCSCC Registry database during the period of 2008-2010. Performance measures were compared at three points: the year before implementation of the stroke nurse coordinator, the implementation year, and, the year after the implementation of the stroke nurse coordinator position.
Results:
Stroke education performance measure scores for the preimplementation year (2008) were 58.1%, which improved to 86.4% for the year that the nurse coordinator position was created and filled, and rose to 96.9% for the 1-year period after the position was filled. Scores from Z tests comparing proportions over time between each of the 3 years were statistically significant.
Conclusions:
Implementation of a stroke nurse coordinator to improve stroke care and education is a coordinated effort that will impact stroke outcomes across the healthcare continuum, with efforts geared toward primary and secondary prevention strategies. This role provides supportive resources for the community, individualized care with patients and families as well as supporting staff in providing stroke education, and awareness. Stroke education has shown improvement in patients understanding the signs and symptoms of stroke as well as improved compliance with treatment plans; the use of a dedicated educator is supported.
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