|During a Joint Commission survey at UCH, Marzena Kowynia, a registered nurse at UCH and PVH, answered questions about the care provided to a 19-year-old woman at UCH who had suffered a subarachnoid hemorrhage, or bleeding into tissues that cover the brain.
The award, the program's third straight, followed a one-day visit April 20 by a Joint Commission surveyor who met with the hospital's administrative and clinical leaders and roamed units, reviewed patient charts and talked with and asked questions of providers.
The goal: Verify that Univeristy of Colorado Hospital has the systems in place to provide superior care and produce improved outcomes for stroke patients.
At the end of the long day, the surveyor came away impressed with the hospital's commitment to providing multidisciplinary care and improving its processes of care, said Alexandra Graves, the stroke program's clinical director.
[Related: PVH stroke program improves patient outcomes]
Show and tell
UCH was able to point to a number of clinical goals it had met since its last recertification survey in 2010, Graves noted.
But seeing is believing, and the surveyor looked over a list of some 300 stroke patients the hospital treated during the past 12 months and randomly selected five she "traced" through the system. Two were patients currently hospitalized; she traced the other three through the electronic medical record (EMR).
"The surveyor put people on the spot," Graves said. "She wanted to see for herself that the individuals in the hospital are stroke-ready and knowledgeable."
The first unit the surveyor visited was the Neuro Intensive Care Unit, where she singled out Marzena Kowynia, a registered nurse who recently completed the hospital's one-year Nurse Residency Program. Kowynia, who worked the Neuro ICU unit during her residency, answered questions about the care provided to a 19-year-old woman who had suffered a subarachnoid hemorrhage, or bleeding into tissues that cover the brain. She spent 21 days on the unit.
In the spotlight
As the first interviewee -- the surveyor would later speak with nurses in the Surgical ICU, the Neurosciences Unit and the Emergency Department -- Kowynia fielded a thorough series of questions, said Graves, who joined the discussion with Stroke Program co-medical director Dr. William Jones and Neuro ICU medical director Dr. Robert Neumann.
"It was a bit nerve-wracking, but the surveyor set me at ease and broke the ice," Kowynia recalled.
Kowynia first provided a report on the patient, including the results of a neurological exam, the care plan, the treatment goals, and medications to manage her pain, nausea, blood pressure, spasming blood vessels, and so on.
The surveyor asked Kowynia to show in the EMR that she and other providers administered swallowing tests, managed blood pressure, minimized the risk of deep-vein thrombosis and other core values used to measure the patient's progress.
The questions covered the broad range of care stroke patients receive. Asked how she knew what to teach the patient, Kowynia pointed to charting in the EMR that showed what other nurses had taught and notes about what the patient learned as her hospital stay progressed.
The nurse also found the first swallow evaluation and showed the patient did not receive medication until the patient showed she could swallow. Pain assessments, Kowynia noted, had been done an hour before and an hour after the patient received medications. She pointed to how social work and case management were woven into the patient's discharge planning.
Any more questions?
The session, which lasted about a half hour, concluded with Kowynia answering the questions to the surveyor's satisfaction. Overall, Graves said, the surveyor noted the hospital's nurses as "a huge strength" of the Stroke Program.
"She found all the nurses knew the patients, the diagnoses and the plan of care," Graves said.
The survey included a stop in the Surgical Intensive Care Unit, where the surveyor traced the case of a heart transplant patient who had suffered an in-hospital stroke. In the Neurosciences Unit, she spoke with registered nurse Anne Harris and a patient hospitalized because of a transient ischemic attack. She also reviewed the EMRs of two patients admitted with ischemic strokes, one of whom received the clot-busting tissue plasminogen activator (tPA) and another who did not.
In the afternoon, the hospital team presented data and outcomes and discussed additional patient charts. The exhaustive review concluded with the Stroke Program receiving one citation for its medication reconciliation process, which the surveyor found "inconsistent," Graves said. The hospital will provide an action plan to show how it will address the issue, she added, noting the surveyor found the problem was a systems issue and not specific to the Stroke Program.
The surveyor also identified several improvement opportunities for the program, including certifying all staff on an acute stroke assessment scale; involving additional departments in collecting stroke data; and exploring partnerships with other hospitals in the state. Graves said she has talked with her counterparts at Poudre Valley Health System about forging a closer relationship and intends to follow up.
And, of course, the hospital's tower expansion, which includes more Neuro ICU beds and a growing Neurosciences program, offers more potential for the Stroke Program.
"The surveyor said she was surprised we don't have more transfers from other hospitals, but that's a goal for us," Graves said.
-By Tyler Smith, managing editor, UCH Insider
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