LAUSR

Introduction: “A Better Way to NIHSS” evaluated feasibility and effectiveness of in-person National Institutes of Health Stroke Scale (NIHSS) training compared to traditional training across a 17-hospital system. Stroke practitioners are encouraged and sometime required to be NIHSS certified. Despite the ubiquity of the scale, it presents challenges for care providers. Items with poor reliability, improper technique, and scoring errors may lead to a lack of recognition of neurologic decline. Standard computer-based training may not effectively prepare RNs. An updated in-person course was needed to improve practitioner satisfaction and scoring accuracy. Hypothesis: We hypothesized that we could improve practitioner satisfaction, scoring accuracy and system efficacy by developing and implementing an in-person NIHSS course. Methods: Pitfalls of traditional computer training were identified by a stroke APN. In collaboration with national and regional subject matter experts, evidence-based curriculum was developed. Emphasis was placed upon live demonstration of exam technique, and student return-demonstration for psychomotor competency. Tools were provided to meet visual and read/write learning styles. Over 1-year, a hospital system collaborated to standardize the curriculum, HR certification and tracking process, and instructor training. Instructors received 1-on-1 training and mentorship to effectively deliver content. Instructors in training often co-taught classes until they were comfortable, had speaker notes to assist them, and training sessions geared to their needs. Standardized evaluation tools, stakeholder input, data, and random chart audits were utilized to evaluate effectiveness. Results: Over 18 months, 14 instructors were trained and 896 RNs certified. Evaluations showed improved learner knowledge, skills, and confidence. Educator training led to improved instructor evaluations. Documentation showed improved accuracy of scoring during random chart audits. Items with greatest improvement were limb ataxia, facial droop, visual fields, and aphasia. Conclusion: Systems should consider implementing and offering in-person NIHSS course to reduce the incidence of improper exam technique and scoring errors.