Successful Implementation of the National Institutes of Health Stroke Scale on a Stroke/Neurovascular Unit

Jenny Richardson; Diana Murray; C. Ken House; Ted Lowenkopf


J Neurosci Nurs. 2006;38(4):309-314. 

In This Article

Abstract and Introduction


The National Institutes of Health Stroke Scale (NIHSS) is accepted as the definitive clinical examination to assess stroke severity. This project examined barriers to implementation and NIHSS use by registered nurses on a stroke/ neurovascular Unit. Staff members were surveyed to determine nurse-perceived barriers to the routine use of the NIHSS. Survey results were used to create interventions including staff education, emphasis on NIHSS assessment during interdisciplinary rounds, and use of pocket cards. When the survey was redistributed 9 months later to verify results of the quality improvement initiative and guide further interventions, NIHSS assessment had increased from 12% to 69%. NIHSS scores have been linked to an existing outcomes database to monitor acute stroke treatment and inpatient management outcomes.


The quality of inpatient care for stroke patients is a matter of national importance. More than 700,000 people in the United States experience a stroke every year, and as many as 30% are permanently disabled. In 2005 the projected direct and indirect costs of stroke in the United States were $56.8 billion (American Heart Association, 2005). Interventions aimed at improving assessment and outcome of acute stroke could positively affect physical, psychological, and financial healthcare measures.

To standardize and optimize stroke patient care, some hospitals have established inpatient stroke units. These geographically defined units are staffed by physicians, nurses, and rehabilitation personnel skilled in the care of stroke patients. Several studies have demonstrated the effectiveness of stroke units in decreasing mortality and morbidity from stroke; the positive effects may persist for years (Alberts et al., 2000; Cavallini, Micieli, Marcheselli, & Quaglini, 2003). A comprehensive approach to patient care is created when staff members working within a stroke unit consistently and routinely use a validated and standardized tool for neurologic assessment in combination with recognized treatment and management guidelines (Criddle, Bonnono, & Fischer, 2003). Routine use of such a tool can improve medical documentation and internal communication between healthcare providers. Additionally, use of a standardized tool for initial neurological assessment and the periodic monitoring of neurological status provides a measure by which to analyze the delivery and quality of care (Spilker & Kongable, 2000). This article addresses the value of using a standardized neurological assessment tool in the care of stroke patients and the integration of such a tool into the practice of registered nurses staffing a stroke/neurovascular unit.


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