1. 1 Soarian Stroke Core Measure Workflow Process The new Stroke Core Measure Workflow will go live on Tuesday, Oct. 23. Certain Triggers will start the workflow process by identifying patients who are possible stroke patients. Nursing Documentation ED Triage form - Cincinnati Stroke Scale (one abnormal finding) ED Adult Medical Assessment – Cincinnati Stroke Scale (one abnormal finding) Admitting Diagnosis Triggers Stroke CVA TIA Altered Mental Status Change in Mental Status AMS Syncope Initial Physician Admitting Orders Stroke TIA Altered/Changed Mental Status Syncope Starts the workflow pushing the following nursing orders Nurse Swallow Screening for Stroke to the Nurse’s Worklist Neuro Stroke FS every 4 hours to the Nurse’s Worklist ED Stroke Core Measure Checklist to the Nurse’s Worklist (Inpt) Stroke Core Measure Checklist to the Nurse’s Worklist Stroke Core Measure Audit Tool to the QA SPW (for Quality nurses only)

2. 2 ED Triage Form Possible Stroke Check box checked will trigger a pop up box to keep patient NPO and the check boxes for the Cincinnati Stroke Scale added One abnormal finding will trigger the last known well date and time and the Source of Data fields Documentation of the last known well date will trigger the pop up as shown and make Source of Data a mandatory field.

3. 3 ED Stroke Core Measure Checklist - Triage time fills into form - Results of the Nurse Swallow Screen fill into form - This is a one time order to be completed from the worklist - Print box for NPO Sign to place in Patient’s room if Patient Fails the Swallow Screening The Nurse Swallow Screening form is now one form to be used by ED and the inpatient areas. There is no longer an “ED Nurse Swallow Screening form”. This is a one time order to be completed from the worklist.

4. 4 Neuro Stroke FS - on the worklist as a Q4hour order - Can be accessed from the filtered list for more frequent neuro checks Inpatient Stroke Core Measure Checklist - Contains the ED Core Measure Checklist documentation - The “Bedded Patient” section is for the nursing documentation of a patient who has been placed as a bedded patient - This form is a PRN order and can only be signed off as complete each time documentation is added

5. 5 A failed swallow screen will result in this Pop Up box displaying when the “Fail” result is documented. Also, a nurse communication order for notifying the physician of the failed result and to obtain an order for a Speech Therapy Consult for Swallow evaluation occurs. If the patient is a direct admit or if a swallow screen was not done in ED, the nurse on the division will complete the screening and the result will fill into the checklist. A NPO Sign print box can be used to print a sign for the patient’s room as needed.

6. 6 Documenting anticoagulants and antithrombolytics ordered can be selected from a drop down list. There is also a drop down value of “other, see comments” as an option if you do not see a medication on the list LDL results, if done within the past 30 days in a Lake Health facility will fill into the form. A drop down list for statins or lipid lowering medications is also available.

7. 7 Stroke education completed on the Stroke Chapter of the Patient Education Form will auto check the education elements below. These elements are required for Stroke Discharge Instructions. If a PT/OT evaluation was completed in Soarian by the Rehab Department, the “Assessed for Rehabilitation” field will display a “Yes” value. If it has not been done yet there will be no value and the “Comments” section will be a mandatory field. Documentation of a follow up to obtaining a Rehab evaluation can be documented here. Other triggers associated with the Workflow: Documentation of Stroke Education in the Stroke Chapter of the Pt Ed form will auto check the “Stroke” element on the Core Measure Chapter of the Shift Asmt. Documentation of the “Stroke” element on the Core Measure Chapter will auto check “Yes” on the Stroke Homegoing (Discharge) Instructions. A failed result on the Nurse Swallow Screening form will send a communication order to nurse to notify the physician of the failed swallow screen and request an order for Speech Therapy to be consulted for a swallow evaluation.