Using the National Institutes of Health Stroke Scale to Safely Evaluate and Treat Stroke Patients

Purpose:
To best evaluate and treat acute stroke patients, an accurate and concise assessment tool to document changes in acute stroke symptoms is needed. To do this, our unit implemented the National Institutes of Health Stroke Scale (NIHSS) paired with a unique tool to carry out and document results.

Significance:
Traditionally the Glasgow Come Scale (GCS) has been the standard for evaluating neurological status however it does not always identify small changes. The NIHSS, primarily used for research patients until now, gives a more precise picture of neurological status and subtle change in stroke patients.

Strategy and Implementation:
At Medstar Washington Hospital Center, the Intermediate Care Neuroscience unit has implemented the NIHSS as a tool to assess neurological status of acute stroke patients. The NIHSS is performed by both physicians and nurses. To facilitate the use of this scale, the unit has created a specific tool; laminated 8.5”x11” NIHSS cards have been placed at the bedside of each patient. These cards contain all of the necessary statements, images, and phrases used to test dysarthria and best language ability. Additionally, one of the pages is a scoring page which corresponds to the unit's computerized documentation system. This large, laminated tool allows nurses to perform the NIHSS at the bedside, record and easily transcribe the score into the electronic documentation system, and then wipe the scoring page clean for the next nurse to use. Nurses on the unit have been certified to perform the NIHSS and have been educated on use of the unit's NIHSS tool and electronic documentation.

Evaluation:
The NIHSS is being carried out each shift for all stroke patients on the unit and nurses are making enthusiastic and habitual use of the unit's NIHSS tool. The NIHSS scores documented by both physicians and nurses on the unit are consistently congruent, falling within a margin of error of ± 2.

Implications for Practice:
The NIHSS provides valuable data for stroke patient assessment. Its use and the resulting interventions implemented allow healthcare providers to best assess and care for patients. The laminated assessment tool at the patient bedside not only encourages use of the NIHSS but is also cost effective.