I work in a rural ED in central Kansas. The facility I work in is a 23 bed critical access hospital, with medical and surgical clinics, a Med-Surg unit, O.R., and small ED. A few years ago, our facility went through the process of becoming an AHA certified “Acute Stroke Ready Hospital”. We are over 125 miles from any hospital that has neurology on-call 24/7. To become certified, our hospital went through changes as outlined in Kotter’s 8 step change process.
- Establishing a Sense of Urgency
Establishing a sense of urgency was easy to do, as treatment for stroke is time-dependent and definitive care requires higher level services than what we can offer.
- Creating the Guiding Coalition
Because the hospital I work in is small, there aren’t too many leaders in our facility. The nurses who took charge of this project were our CNO, ER manager, and our 3 shift supervisors, the medical director also helped lead the change for the providers.
- Developing a Vision and Strategy
The key reasons for the change was to optimize the care of patients with acute strokes, both in the ED and Med-Surg departments. The vision was easily executed by following AHA’s guidelines for becoming “acute stroke ready”.
- Communicating the Change Vision
Nursing staff was first notified of the change during the monthly nurses’ meeting. Flyers were posted with information regarding the change. Some nurses were nervous about learning to perform the NIH stroke scale, but anxieties were relieved by the realization that this education would enable the nurses to be more confident in stroke care.
- Empowering Employees for Broad-Based Action
The first staff members to complete training were the nursing managers and shift supervisors. Then they taught the staff nurses how to use the new equipment, and assisted them to complete the NIH stroke scale training. Rewards came in the process, employees were encouraged to enter a contest to name the teleconsultation robot, and the winner was featured in the local newspaper.
- Generating Short-Term Wins
The sure-fire projects were completing the NIH stroke scale training.
- Consolidating Gains and Producing More Change
After the nurses and providers were trained in the telemedicine consults and the NIH stroke scale, the new Acute Stroke protocols were put into place in the ED and Med-Surg units. The nurses and providers attended training on administration and use of TPA for ischemic stroke.
- Anchoring New Approaches in the Culture
There was still some resistance to utilizing the telemedicine consultation robot by the providers, so the protocols were changed so the nurses will initiate the consultations, rather than the providers. Because the facility is so small, the CNO or ER director will often congratulate the individual nurses involved in care of stroke patients. Stories of success with TPA often spread to nurses working in other departments.
Steven Thomsen. (2013, February 17). KOTTER’S 8 STEP ORGANIZATIONAL CHANGE MODEL FC. [Video File]. Retrieved May 11, 2017, from https://www.youtube.com/watch?v=LxtF4OXzhyI#action=share
American Heart Association (AHA). (2018). Acute Stroke Ready Hospital Certification. Retrieved from http://www.heart.org/HEARTORG/General/Acute-Stroke-Ready- Hospital_UCM_473926_SubHomePage.jsp
I appreciate the succinct yet informative assessment you have provided. Stroke identification and treatment is vitally important. The residual effects of strokes can be devastating to patients and families. I have often wondered what it would be like to live in a rural community. My wife and I both agree that access to critical care medical services is a major factor in our decision to remain in a metropolitan community. After reading your piece I find my concerns assuaged a bit. I commend you for your services to your community. Keep up the good work.
Jason
Small rural communities always have their own set of problems. They are such a pivotal step between the home and the urban hospital setting. They are really the key in some situations where quick responses are make or break. Strokes are a prime example. Rural community nurses are a multi-skilled set of nurses that are more rounded, less specialized then those of us in larger setting. Adding this skill set to your hospital is commendable and necessary for the community you work within. I can appreciate the apprehension the nurses felt at the beginning. It is a big responsibility but I am glad that it was accepted and worked out well for you guys.
I think this is a great plan to have in a rural community hospital. Strokes is a very serious thing and being able to have a hospital that can adequately evaluate and treat a patient appropriately is detrimental to patients. What a huge asset to people in that area especially with have to travel 125 miles to the nearest hospital with neurological care. I am sure that a lot of protocols and training was underwent for this transition. I am sure it was a difficult time for people with all that changes but what a huge reward in the end. Better patient care and that is all that you can ask for. I commend your hospital for taking the next step for the patient. I am glad to hear that it all worked out well for your hospital.
The is great that your rural community hospital was able to become a certified stroke facility. Sounds like it took a lot time and steps to get that process to happen. It is probably reassuring to people that you able to treat these patients knowing that the next closest facility is 125 miles away.