NIHSS stroke scale

misswoosie · Oct 10, 2008

Nice to hear from other Neuro nurses. Where in the UK. I also do air ambulance and repatriated a man back to London in December. Sorry, I don't remember the name of the hospital. It was near the airport but it wasn't Healthrow. Our NIHS use is based on the American Stroke Assoc. 7 days would easily place most out of hospital here so a DC time is still close to yours. I work as a coordinator for all strokes in a 1,000 bed facility. Respond to in house strokes and the ER during the day shift. Do you have established clinical care pathways? We have dedicated orders but are gearing up for clinical pathways. Yes, it is nice to see a recovery before your eyes. take care.

Link to our multidisciplinary stroke pathway and thrombolysis protocol here.

Anyone in the UK using ROSIER as a triage diagnostic tool in the emergency department ?

http://www.northumbria.nhs.uk/menu.asp?id=258565

Beentheredonethat · Oct 11, 2008

Misswoosie:

Thank you for taking the time to respond to my request and a big hug and kiss for all the information! I have spent several hours reviewing the information and have to say I am envious. You guys have this down to a very simple but comprehensive application. I am going to incorporate many of the presentations for our program. Hopefully, this will help our staff to overcome their resistance and give them the knowledge to improve their practice. :loveya:

allnurses Guide · Oct 11, 2008

I don't understand how people think it's time consuming and/or "arduous" - it takes less than 10 minutes and is both diagnostically and prognostically important. The more often you do it, the quicker you get.

Beentheredonethat · Oct 11, 2008

Your institution can establish their own "standard of practice". In the case of acute stroke we use it in two different time tables.

If the pt received tpa we use it during the emergency workup, two hours post tpa, 24 post onset of symptoms and at discharge.

If the pt did not receive tpa we use it during the emergency workup, 24 post onset of symptoms and at DC.

I think I hear a little concern in your voice. Relax, the NIHSS is just a neuro exam that gives a number. Using it will insure a complete exam of your pt and help to refine your assessment skills. There are plenty of on line education formats to help you to learn how to use it. Just google NIHSS. We actually pay our staff for 4 hours of eduation when they become certified in NIHSS. If you are treating acute stroke pts, staff who assess during the tpa workup must be certified. Happy learning! :specs:

misswoosie · Oct 11, 2008

Thanks Beentheredonethat-you are very welcome.

I am not even sure if ROSIER (Recognition Of Stroke in ER) has been added to our protocol yet.It is an excellent tool which was developed for use by Doctors in ER, but is now being validated for use by paramedics. It is a step up from FAST, and aims to predict the likelyhood of stroke being the cause of the neurological deficit.

So presence of certain things are scored positively,whilst others are scored negatively.

As for NIHSS it was first developed purely for thrombolysis patients, and they are the only patients we use it for. Initially I used it for thrombolysis clinical trials 10 years ago and it does require certification every 2 years.

There is actually a move away from using the NIHSS in thrombolysis, purely because it is not an easy scale to use and requires some practice.

A patient can have an NIHHSS of 0 and still have had a stroke, so it is not a substitute for a full neuro exam to assess the type of stroke a patient has had ie the Bamford classification of stroke ie LACI,PACI,POCI or TACI.

It is the BAMFORD classification (plus CT evidence etc) which people use to quote mortality/recovery rates , either with or without thrombolysis treatment.

With experience you can tell very quickly using FAST and a few other quick tests what type of stroke they have had.

Beentheredonethat · Oct 11, 2008

I reviewed the ROSIER info you sent. It is similar to a screen that is now being taught to our EMS folks and I recently introduced to our ER and rapid response team. Called the MEND exam. Short for Miami Emergency Neurologic Diagnostic. It is also a yes/no format that is fast, simple to use and a good indicator of stroke and stroke snydrome. Our equivalent of your Bamford classification. Our staff is not as sophisticated so trying to wean them away from an alert and oriented, moves all extemities assessment meant we needed a common format for them to adhere to. For now we are using the NIHSS until they build their skill set and can move forward. I really was envious of the baseline level of care that your system has. In many areas in the US we are still fighting the old attitude of nothing can be done for stroke and bare bones neuro exams. The fastest way to clear a room of nurses here :banghead: is to ask them to perform a neuro exam. Thanks again for your info and support. :up:

misswoosie · Oct 11, 2008

The level of care stroke patients receive varies depending on the comittment of the Stroke physicians in any hospital, or it did until the Department of health brought the National Stroke strategy earlier this year.

Now everyone has to have access to a stroke thrombolysis service, whether that be at a regional center or their local hospital. Bit difficult to have a regional service when we are in a fairly rural area with no air ambulances with the 3 hr timescale-of course the results of ECASS III released 2 weeks ago showed it was beneficial up to 4.5 HOURS.

I have heard of MENDS -if you don't mind telling me -what is your job title and which state do you work in? You can PM me if you want

gwapo · Oct 15, 2008

hello. it's my fist posting in this thread. i work in an MSICU somewhere in southwest florida and recently, they have decided to have us do NIHSS on every neuro patient. Does this make sense? As I understand it, NIHSS is used for stroke patients to provide a baseline assessment prior to treatment (tpa or whatever) and evaluate effectiveness of it. I know all stroke patients are neuro patients, but not all neuro patients are actually stroke. So why do NIHSS on all neuro patients??? Any input will be appreciated. thank you.:banghead: :no: :argue:

misswoosie · Oct 15, 2008

Hi

Excuse me as I am in the UK-but what is MSICU?

The NIHSS (National Institute for Health STROKE Scale) was as you say developed for Stroke patients.

I guess you could use it on head injury patients to assess neurological deficit, maybe???

What other type of patients do you care for?

If they are doing it at admission to screen for stroke then it's not really appropriate and a Stroke screening tools ie ROSIER,MENDS,FAST would be better.

Hope this helps!

gwapo · Oct 15, 2008

Hi
Excuse me as I am in the UK-but what is MSICU?
The NIHSS (National Institute for Health STROKE Scale) was as you say developed for Stroke patients.
I guess you could use it on head injury patients to assess neurological deficit, maybe???
What other type of patients do you care for?
If they are doing it at admission to screen for stroke then it's not really appropriate and a Stroke screening tools ie ROSIER,MENDS,FAST would be better.
Hope this helps!

MSICU= med/surg icu. last weekend i had a patient who came from OR post craniotomy for suspected glioblastoma.usually, we won't do an NIHSS on her, but since they want us to have it done on all patients, we did it anyway. does it make sense?

Beentheredonethat · Oct 15, 2008

This is a good question and one that was asked by our staff after we instituted the same policy. First, you are right that the NIHS is used for stroke. What we found is that there has been resistance to using the NIHS and often the folks who resisted did not have the best neuro assessment skills. Neuro exams without a scale have often been subject to a wide range of subjective rather than objective interpretation and difficult for one person's assessment to be validated by anothers. In short, it helped to standardize everyones exam.

It isn't perfect, but there aren't too many scales out there and it is the most used so it acility and another. Once you have it under your belt it won't take any time at all to perform.

Beentheredonethat · Oct 16, 2008

Sorry, the key board died so the rest of the message did not make it. I was going to say that it provides a common language between shift, departments and other facilities.