Nurse Driven Standards of Unit Specific Knowledge Team

Nurse Driven Standards of Unit Specific Knowledge Team Members: Angela Starkweather, Barbara Buturusis, PJ Vivirito, Paul Sewing, Michael Schneck, Peter Letarte, Tracy Berman

Opportunity Statement The increasing complexity of care delivery for neuroscience patients requires nursing staff to have a specific knowledge base and technical skills in order to follow trends in patient status, document variations and provide safe and effective treatment regimens The knowledge and technical skills needed can be gained through additional education and/or certification

Most Likely Causes Identified Through Data Standards of nursing knowledge for the neuroscience patient population are not clearly defined in the literature. Certification in Advanced Cardiac Life Support or by specialty nursing organizations is not required for practice with the neuroscience patient but is encouraged in the literature. Complex assessment and diagnostic instruments are used by neuroscience practitioners and are not currently used by the nursing staff which can interfere with communication between disciplines.

Solutions Implemented Encourage ACLS certification for ICU nursing staff by providing educational days to attend ACLS classes and paying for the certification. Provide nursing staff on 2 NE and 2 WICU with inservice education on commonly used neuroscience instruments (Glasgow Coma Scale, NIH Stroke Scale, Hunt and Hess classification, Fischer Grading Scale, House and Brackmann Grading Scale, cranial nerve assessment and seizure classification) that are documented in daily progress notes and used to plan treatment regimens for neuroscience patients.

Solutions Implemented Develop neuroscience specific instrument reference sheets for nursing staff to use on their clipboards. Encourage nursing staff to become certified in critical care (CCRN exam) by providing resource books for certification preparation. These reference guides are located in the 2 WICU.

Reference Sheets

Results Working within the 2 WICU budget, the nursing staff has been encouraged by the manager to pursue ACLS certification on a seniority basis. Over one year, 50% of the staff has become ACLS certified and it is projected that by next year, the entire staff will be ACLS certified.

Education on Neuroscience Instruments Pre-test and Post-test Results 2 West ICU nursing staff (n=28) and 2 NE nursing staff (n=38) demonstrated significant improvements in assessment, classification and treatment regimens of neuroscience patients.

Recommendations for Further Study or Action Continue encouraging 2 WICU staff to attain ACLS certification by providing education days and reimbursement for taking the class. Collect post-test results on the in-service education provided at the six month interval to track knowledge level over time. Provide these learning opportunities for new hires.

Recommendations for Further Study or Action Consider reimbursement for taking the Critical-Care Nurse Certification exam. Develop quality indicators and correlate increases in unit-specific knowledge with patient related quality measures.