Background:
Carotid endarterectomy (CEA) and carotid stenting (CAS) procedures are performed by 3 service lines- neurosurgery, neurology, and vascular surgery in our academic medical facility. Despite 3 services caring for carotid disease patients, post-procedural nursing care is managed utilizing service line specific protocols and order sets that differ in content creating variations in post-procedural nursing care delivered on service line specific nursing units. This lack of standardization yielded variations in post-procedural nursing care and recommendations for improvement (RFI) during the hospital’s Comprehensive Stroke Center Joint Commission survey.
Purpose:
The purpose of this project is to standardize post-procedural nursing care provided to CEA/CAS patients across neurosurgery, neurology, and vascular surgery.
Methods:
Creation of a shared CEA/CAS order set among neurosurgery, neurology, and vascular surgery developed with input and agreement from providers; education was provided to nurses and physicians. Patients were prospectively identified by the stroke quality nurse, and notification was sent to post-procedural units to ensure the new CEA/CAS protocol and order set was utilized to guide post-procedural nursing care. Auditing 100% of cases for order set and protocol utilization, and real time feedback to nurses and providers on non-compliance was completed by the stroke quality nurse.
Results:
A total of 219 patients (120 pre and 99 post) were retrospectively reviewed in a pre and post cohort analysis. Order set utilization increased from 74.1% pre to 86.8% post (12.7% increase; likelihood ratio p = 0.011) over 18 months. Adherence to CEA/CAS care protocol and nursing documentation improved thus no associated RFIs in our 2019 stroke reaccreditation survey.
Conclusion:
Multi-disciplinary collaboration to create a uniform protocol and order set to guide post-procedural nursing care, in conjunction with a formal implementation and validation plan, results in successful standardization of post-procedural nursing care of the CEA/CAS patient population across 3 service lines and nursing units.