Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

The development and implementation of the Focal Neurological Observation Tool (F-NOT) using an interdisciplinary approach in a quaternary hospital in Queensland (#188)

Meaghan Osborne 1 , Claire Muller 1 , Kristina O'Dwyer 2 , Julian de Looze 3 , Mia McLanders 4 , Pamela McCombe 1 , Shaune Gifford 5 , Andrew Wong 1
  1. Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  2. Quality, Innovation and Patient Safety Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  3. Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  4. Clinical Skills Development Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  5. Patient Safety and Quality Improvement Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

Background:

The Glasgow Coma Scale (GCS) is insensitive for identifying focal neurological deterioration in neurological and stroke syndromes.

Aims:

To develop and implement a practical and sensitive neurological observation tool to improve the early detection of focal neurological deterioration in an inpatient population.

Methods:

The Focal Neurological Observation Tool (F-NOT) was developed to identify early neurological deterioration in neurology and stroke patients prior to them triggering a Medical Emergency Response Team (MERT) response through GCS-based escalation criteria. Changes in addition to the GCS included the addition of focal neurological assessments, escalation requirements, and a track-and-trend addition to limb power assessment. Success was therefore defined as a reduction in MERT activations for neurological deterioration.

We used rapid cycles of change in consultation with subject-matter experts to create the tool. F-NOT was trialled in several clinical areas in metropolitan, regional and rural facilities across Queensland. Users received pre-trial Just-In-Time training and viewed instructional media.  A 4-month consultation period, 17 early iterations, and 4 further revisions were based on trial feedback including qualitative surveys assessing useability and efficacy.

Results:

Using F-NOT, per month median MERTs for neurological deterioration decreased by 33.3% from pre-implementation (58.5/month) to post (39/month), indicating improved early identification of neurological deterioration.

A survey of 31 nurses found the tool easy-to-use (72%), accurate at identifying deteriorating patients (76%), and recognized that it assisted in obtaining an urgent medical review (68%). 100% compliance was demonstrated with GCS and limb power assessment.

Conclusions:

F-NOT is a novel user-endorsed neurological assessment tool that demonstrated improvement in early detection of neurological deterioration resulting in fewer MERTs, prompt medical review, and improved patient safety. The tool is currently being implemented state-wide with plans for further study amongst experienced and novice nurses and medical staff.