Improving the Stroke Education Performance Measure (STK8)

Elaine Tsiakopoulos, RN, MSN, Carmen Harris-Frowner, RN, BSN, ACM, Carol Hardeman-Miller, MSN, RN, Patrice Moore, BSN, RN, M.Ed, Nancy Scott , DNP, APN, Patience Tieri RN, BSN

Background Aims

The Intervention

Lessons Learned

•  To improve the Stroke Education Core Measure (STK-8) from 41% compliance through nursing education and collaboration. •  Encourage utilization of the Patient Education Tool for documentation of Stroke Education.

•  Nursing education, Epic and Quality collaborated on the documentation necessary to capture the components of this measure. •  Documentation education was presented on the Neurology Units to ensure consistent documentation within the Patient Education Tool utilizing a multimedia, checklist, and tracer approach. •  A mechanism for feedback regarding performance was created between Nursing Management, Center for Nursing Professional Practice & Research with Quality through Outlier Letters. •  Abstracted non-compliant cases are communicated via email to Nursing Education for follow-up with Nursing and Management. •  Outlier Letter compliance is reported out at the monthly Primary Stroke Center meetings. •  Overall measure performance is reported out at the monthly Primary Stroke Center meetings in a control chart for opportunities for improvement.

•  Comprehensive Stroke Center standards of care need to be incorporated into the core education of all nursing staff during orientation and annually. •  Comprehensive Stroke Center core measure performance needs to be communicated to the interdisciplinary team on a quarterly basis. •  The feedback loop is essential for improvement.

Next Steps

Results

•  Performance improved to 100% for the months of June, July, September, October, January and February. •  Outliers for August, November and December were not on Neurology Specialty Units. •  Mean performance is at 74.6%

•  STK-8 Stroke Education is an externally reported National Quality Indicator that is publically available through the Center for Medicare and Medicaid (CMS) Quality Measures on the Hospital Compare website - www.medicare.gov/hospitalcompare/ •  Ischemic or hemorrhagic stroke patients or their caregivers who were given education materials during the hospital stay addressing all of the following: activation of EMS, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. •  Current performance was 41% well below the Illinois Average of 84% and below the National Average of 85%.

•  Development of an automated report system that captures stroke patients and their associated core measures. •  Development of standardized templates for the interdisciplinary team notes to facilitate communication of patient’s progress and addressed core measures.

Contact: Elaine.Tsiakopoulos@uchospitals.edu

40.00%  

50.00%  

60.00%  

70.00%  

80.00%  

90.00%  

100.00%  

Week  1  Week  2  Week  3  Week  4  Week  5  Week  6  Week  7  Week  8  

G4P   Std.  Campaign   Baseline  

40.00%  

50.00%  

60.00%  

70.00%  

80.00%  

90.00%  

100.00%  

Week  1  Week  2  Week  3  Week  4  Week  5  Week  6  Week  7  Week  8  

G4P   Std.  Campaign   Baseline  

Definition: STK-8 includes patients with an principal diagnosis code for ischemic or hemorrhagic stroke discharged to home, home care or court/law enforcement given education regarding activation of emergency medical system, need for follow-up post-discharge, medications prescribed at discharge, risk factors for stroke and warning signs and symptoms of stroke. Note: Patients <18 years, a LOS >120 days, patients on ‘Comfort Measures Only’, enrolled in clinical trials, those admitted for elective carotid intervention are excluded from STK-8. Sampling: Yes, based on CMS guidelines Data Source: Clinical documentation nurse chart review from Epic / MR View

Baseline: 58.0% Standard HH Campaign: 72.3%, p<0.001 Giving for Performance: 83.9%, p=0.003

References: •  Joint Commission Resources. Advanced Disease-Specific Care Certification Requirements for Comprehensive Stroke Center (CSC) Chapter in the 2013 Disease-Specific Care Certification Manual. Accessed Jan 13, 2014. http://www.jointcommission.org/certification/advanced_certification_comprehensive_stroke_centers.aspx. •  Roger, E.(2003). Diffusion of Innovations (5th ed.) Chicago, IL., Simmon & Schuster. •  Gawande,A. (2010). The Checklist Manifesto-How To Get Things Right. New York, NY., Henry Holt & Company.