1. Implementing the NIHSS In Your Organization January 2008

2. Implementing the NIHSS in Your Organization  There are several common steps for developing policies, procedures and forms in organizations:  Identify the need  Develop the document and plan the implementation  Consult with stakeholders  Obtain signatures for approval  Implement and evaluate  It is important to determine the process within your organization and follow those steps.

3. Identifying the Need  Consult with department/committee in charge of policy and procedure development to identify that you would like to implement the NIHSS within your organization and determine your next steps.  Review guidelines for developing policy and procedures in your organization.

4. Develop the Document & Plan Implementation  Form a project working group of stakeholders to discuss development and plan for implementation. Members should be willing to champion the change process.  Adapt templates for NIHSS policy, procedure and record provided in NIHSS Workshop Package to meet policy, procedure and health records guidelines, and the clinical needs of your organization.  Develop an implementation plan for communication, education, implementation and evaluation of the document.  Identify potential issues and strategies for resolution.

5. Consult with Stakeholders & Obtain Approval Signatures  Forward draft procedure and record with necessary documentation to stakeholders and relevant committees asking for review and feedback within specified timeframe.  Review feedback and revise documents as required.  Review and confirm final document and approval signatures required with Policy and Procedure Committee.  Obtain approval signatures.  Forward form for approval by Policy and Procedure Committee and Health Records Committee.

6. Implement the Document & Evaluate  Involve key educators and champions from units who are implementing the NIHSS and encourage their attendance at a NIHSS Workshop to develop expertise.  Develop and implement an educational training plan for front line staff to meet the needs of the unit using resources provided in training workshop.

7. Implement, cont…  Suggestions for training modalities:  3 hour workshop (see agenda) plus practice clinically OR  Self directed learning via online certification THEN  Return demonstration of skills clinically with an preceptor/educator

8. Suggested Training Workshop for Front Line Staff  3 hour workshop:  15 minutesWelcome and Meeting Objectives  60 minutesNational Institutes of Health Stroke Scale: Overview and Demonstrations  60 minutesPractice with Partner  45 minutesPatient Assessment Simulations Wrap Up

9. Implement cont…  Develop a documentation audit form for NIHSS Tool and/or observation record to ensure guidelines for use are followed and appropriate action is taken when NIHSS decreases during implementation period and ongoing.  Build in some reliability testing using trained experts such as educators and staff to ensure reliability of assessment during implementation period and ongoing.  Consider annual review or demonstration of competency.