Ratanaporn Yontrakul, Nisakorn Vibulchai, Wiriporn Pinnadilay, Julintorn Sripontun and Benjaphon Aengwanich
Mahasarakham Hospital, Thailand
Posters & Accepted Abstracts: J Nurs Care
The mutual collaborative action research aimed to develop the fast track service system for patients with ischemic stroke in the context of a tertiary care hospital and service network. Target groups consisted of four groups: 1) data record forms for ischemic stroke 2) ischemic stroke patients 3) caregivers, and 4) nurse case managers. Data were conducted from July 2013 to September 2015. The study process was composed of three phases: 1) situational analysis, 2) service process development, and 3) evaluation. Research instruments included the data record form for ischemic stroke, an evaluation form for practice related to the standard care pathway, questions for interviewing caregivers, and questions for focused group. Data were analyzed by descriptive statistics and content analysis. Results: Situational analysis phase: problems of fast track service were reported in both process and outcome domains. Development phase: three action research cycles were as following1) rapid access to stroke fast track 2) patient screening 3) care process by multidisciplinary team; 4) consulting system 5) development of the standard care pathway, the clinical nursing practice guideline, and referral tools and 6) patient follow up and outcome evaluation. Evaluation phase: 100% of multidisciplinary team followed the standard care pathway. Average duration of door to rt-PA decreased from 67.17 to 46.79 minutes. Ischemic stroke patients receiving rt-PA within 60 minutes increased from 9.26 % to 30.63 %. There were no complications related to aspiration pneumonia, pressure sore, and fall. 70.5% of patients had an improvement in stroke outcomes.
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