scholarly journals 159 Improving baseline measurement of blood glucose and cholesterol levels in acute stroke patients: a quality improvement project

2020 ◽  
Author(s):  
Ayesha Khan ◽  
Shruti Dorai
Keyword(s):  
Quality Improvement ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Quality Improvement Project ◽  
Baseline Measurement ◽  
Stroke Patients ◽  
Improvement Project ◽  
Cholesterol Levels

scholarly journals Optimising the measurement of blood glucose and cholesterol in patients who had an acute stroke: a quality improvement project

2021 ◽  
Vol 10 (2) ◽  
pp. e001237
Author(s):  
Ayesha Rehan Khan ◽  
Shruti Dorai ◽  
Yaseen Serry
Keyword(s):  
Quality Improvement ◽  
Blood Glucose ◽  
Acute Stroke ◽  
District General Hospital ◽  
Serum Glucose ◽  
Improvement Project ◽  
Blood Tests ◽  
Cholesterol Levels ◽  
Effective Interventions ◽  
Suspected Stroke

Hypercholesterolaemia and diabetes are established modifiable risk factors for cerebrovascular disease. A baseline audit carried out on an acute stroke ward at a District General Hospital in East Kent showed variability in blood tests being requested on admission for patients who had a suspected stroke, in particular serum glucose and cholesterol levels. Our aim was to ensure that at least 80% of patients admitted to the stroke ward with a suspected stroke had blood glucose and cholesterol levels measured on admission, over an 18-week period.The percentage of patients admitted with a suspected stroke on the ward who had the appropriate investigations requested on admission was measured weekly. Quality improvement methodology was used to formulate three interventions in the form of Plan-Do-Study-Act cycles: (1) an educational email sent to doctors regarding the assessment of patients who had a stroke and admission blood tests required; (2) adaptation of the ‘Stroke Admission Clerking Proforma’ to include a list of bloods to be requested; (3) production of an all-inclusive ‘Stroke Bloods Panel’ on the online system for requesting bloods.At baseline, an average of 30% and 34% of patients had glucose and cholesterol levels requested on admission, respectively. These results increased to 43% and 40% after the first intervention; 71% and 61% after the second intervention; and after the final intervention, on average, 82% and 85% of patients had glucose and cholesterol levels requested, respectively. We therefore achieved our aim of ensuring that more than 80% of patients who had an acute stroke had the appropriate blood tests requested on admission.The modified stroke proforma and the blood panel were the most effective interventions. The changes were implemented in an additional hospital within the same Trust. We anticipate greater compliance with Royal College of Physicians (RCP), National Institute for Health & Care Excellence (NICE) and Trust guidelines regarding appropriate and timely prescription of antidiabetic and cholesterol-lowering medications for secondary preventative measures.

A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients

2020 ◽  
Vol 52 (4) ◽  
pp. 186-191
Author(s):  
Carol J. Droegemueller ◽  
Bhavani Kashyap ◽  
Roberta L. Huna Wagner ◽  
Hannah Shibeshi ◽  
Mitchell W. Clayton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Hospitalized Patients ◽  
Quality Improvement Project ◽  
Improvement Project

Abstract TP380: Improving Outcomes for Stroke Patients at Risk for Cognitive and Mood Impairments

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sanny Djoeva ◽  
Melissa N Lara-Angulo
Keyword(s):  
Quality Improvement ◽  
Cognitive Decline ◽  
Medical Center ◽  
Academic Medical Center ◽  
Quality Improvement Project ◽  
Provider Education ◽  
Stroke Patients ◽  
Post Intervention ◽  
Improvement Project ◽  
Referral Compliance

Background: Improved survival rates of stroke patients have resulted in a rise in disability within this population. Research demonstrates that stroke patients are at high risk for cognitive decline and depression. Neuropsychological intervention can improve outcomes for this population. At an academic medical center in the Midwest, the process in which stroke patients are screened for these impairments and subsequently referred to a neuropsychologist is ineffective. Purpose: The purpose of this quality improvement project was to critically appraise the process in which stroke patients are screened for cognitive decline and depression and to improve the process using a multi-disciplinary approach of nursing, medicine, rehabilitation and neuropsychology. Methods: A total of 231 patient charts were reviewed in this quality improvement project. The Plan-Do-Study-Act model was utilized. Process changes included: provider education on order placement of neuropsychology referrals, occupational therapist education on correct progress note use, and improvement of visibility of the stroke patient list to screening staff. Pre- and post-intervention data were examined to assess for changes in screening compliance and consultations. Results: Baseline data collected December 2016 showed 64% compliance with Montreal Cognitive Assessment (MoCA) screening, 50% compliance with Patient Health Questionnaire (PHQ-2) screening, and 50% compliance with neuropsychology referral. After new processes were implemented, April 2016 data showed 100% MoCA compliance, 95% PHQ-2 compliance, and 100% neuropsychology referral compliance. Although these numbers look promising, we will continue to gather and analyze data to ensure this positive compliance trend continues. Conclusion: Multidisciplinary education and increased visibility of stroke patients requiring a screening may increase compliance of cognitive decline and depression screening as well as subsequent referral to neuropsychology. The increase in screening compliance will ultimately lead to appropriate referrals and further resources for the stroke population.

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