Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2026

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Karen Kesten DNP, APRN, CCNS, CNE, ANEF, FAAN

Keywords

Stroke Care; Quality Improvement; Nursing; Electronic Health Record; Acute Stroke Care

Abstract

Background: Inconsistent and nonuniform RN stroke handoffs are a major barrier to meeting quality metrics set by The Joint Commission. Effective RN stroke handoffs enhance communication, documentation adherence, and supports better patient outcomes.

Objectives: The purpose of this QI project was to enhance stroke care by using a structured RN handoff tool. Outcomes for evaluation consisted of two components: 1) increase stroke metric documentation adherence rates and 2) increase RN satisfaction on stroke handoff.

Methods: A pre-implementation and post-implementation design was used for this project on a medical stroke unit at a community hospital in the mid-Atlantic region. Implementation of the Get with the Guidelines Acute Stroke Care (GWTG-ASC) tool occurred over six weeks. Retrospective electronic chart audits reviewed adherence rates to stroke documentation metrics (e.g. neurological checks, DVT/VTE prophylaxis, SBP goal, stroke order set, and patient education). Overall adherence scores were calculated per chart, along with an average compliance across the five metrics. RN satisfaction was measured through the Nursing Handoff Report Satisfaction Survey (NHRSS) via REDCap.

Results: 76 retrospective chart reviews were conducted for both phases (total = 152). 27 RNs participated in the project. There was a 9.21% increase in overall documentation adherence from pre-implementation (n = 47, 61.84%) and post-implementation (n = 54, 71.05%). These results were not statistically significant (p > 0.05). Four of the five stroke metrics improved. RN handoff satisfaction improved significantly (p = 0.01), with mean scores increasing by 2.76 points and total participation rising to 92.59%. Improved communication, accuracy, and consistency were reported, though convenience remained the top concern.

Conclusions: Improved documentation adherence and RN satisfaction suggests that the GWTG- ASC tool is a valuable resource during stroke handoff. Integration of the GWTG-ASC tool into the electronic health record (EHR) is recommended to enhance workflow efficiency, improve documentation accuracy, and support sustainability.

Open Access

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