TY - JOUR
T1 - Q-15 Minutes Vital Sign Documentation Is a Poor Surrogate for Assessing Quality of Care after Acute Ischemic Stroke
AU - Stone, Suzanne
AU - Zhao, Huihan
AU - Nyancho, Daniel
AU - Schneider, Nathan J.
AU - Shang, Ty
AU - Olson, Daiwai M.
N1 - Publisher Copyright:
© Lippincott Williams & Wilkins.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Objective Documenting vital signs and National Institutes of Health Stroke Scale (NIHSS) once every 15 minutes after intravenous thrombolytic therapy for acute ischemic stroke is often used as a metric to assess the quality of care. This study explores the association between "once every 15 minutes"documentation and stroke outcomes. Methods This is a retrospective study of the first 2 hours of vital signs and NIHSS documentation after thrombolytic stroke therapy. Sociodemographic and clinical data, including NIHSS, temperature, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and respiratory rate, were abstracted from the medical record. Missing documentation was examined for association with modified Rankin Scale (mRS) scores and neurologic changes. Result Among 84 patients with a mean age of 68.8 years, there were 2276 documented assessments from an expected 3780. There were 104 clinically significant changes in 1 or more index variables. The most commonly missed documentation occurred during interventional radiology. After controlling for admission NIHSS, there was no significant relationship between the completeness of documentation and discharge mRS score (r2 = 0.047, P =.0561), nor between vital sign documentation and discharge mRS (r2 = 0.003, P =.6338). Conclusion Frequency of documentation does not reflect the quality of care during the early phase of acute stroke treatment.
AB - Objective Documenting vital signs and National Institutes of Health Stroke Scale (NIHSS) once every 15 minutes after intravenous thrombolytic therapy for acute ischemic stroke is often used as a metric to assess the quality of care. This study explores the association between "once every 15 minutes"documentation and stroke outcomes. Methods This is a retrospective study of the first 2 hours of vital signs and NIHSS documentation after thrombolytic stroke therapy. Sociodemographic and clinical data, including NIHSS, temperature, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and respiratory rate, were abstracted from the medical record. Missing documentation was examined for association with modified Rankin Scale (mRS) scores and neurologic changes. Result Among 84 patients with a mean age of 68.8 years, there were 2276 documented assessments from an expected 3780. There were 104 clinically significant changes in 1 or more index variables. The most commonly missed documentation occurred during interventional radiology. After controlling for admission NIHSS, there was no significant relationship between the completeness of documentation and discharge mRS score (r2 = 0.047, P =.0561), nor between vital sign documentation and discharge mRS (r2 = 0.003, P =.6338). Conclusion Frequency of documentation does not reflect the quality of care during the early phase of acute stroke treatment.
KW - Acute ischemic stroke
KW - Alteplase
KW - Assessment
KW - Nursing
KW - Outcomes
KW - Quality of care
KW - Stroke
KW - Thrombolytic therapy
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U2 - 10.1097/DCC.0000000000000492
DO - 10.1097/DCC.0000000000000492
M3 - Article
C2 - 34606223
AN - SCOPUS:85117631265
SN - 0730-4625
VL - 40
SP - 328
EP - 332
JO - Dimensions of Critical Care Nursing
JF - Dimensions of Critical Care Nursing
IS - 6
ER -