QUESTION:

What is the community standard on frequency of vital signs and neuro

checks on you stroke order sets
!NSWE"S:
#ost t#! Q$% &ith modified NI%SS ' ()h* then Q( in I+U, Q)h on the
floor for any stroke -atient.
We have ada-ted our orders from the !lte-lase insert and inlcuded /S monitoring as
-art of our order set 0I have attached a co-y that you may share1.
/S 2 Neuro +hecks are done q ) hours for the first )3 hr or 4ased on &hat the
-hysician orders.
+ritical +are555every one hour
Neuro ste- do&n every ( hours
6eneral Neuro floor55every ) hours
7or all t#! -atients* &e follo& the recommended !%!8!S!
guidelines. 7or telemetry -atients* it9s q ) hrs* for all others* it9s
q shift and &ith any change in neurological condition unless other&ise
s-ecified 4y :;.
7or -ost alte-lase -atients 5 q$<mins')* then q=>mins'(* then q$hr '
() hrs 5 o4viously done in the +ritical +are. 7or all stroke admitted
-atients to the acute floors it is q$hr ' ()hrs and then q)hrs.
/ital signs are every hour in the I+U and every ) hours on the neuro
unit. We -erform neuro e'ams on admission* then every ( hours for ()
hours and then every ) hours5no matter &hich unit they are on. The
NI%SS is -erformed also on admission and then the modified NI% cale
is used &ith the same frequency as the neuro e'ams5q( ' () hours*
then q) hours.
standard -ost t#!* ++U Q (* stroke unit Q)
We use the following during t-PA administration and immediately following-
B/P,HR AND NER! "HE"#$ E%ER& '( )*N$ DR*N+ ,REA,)EN,
AND ,HEN -!R AN!,HER . H!R$, ,HEN E%ER& /0 )*N$1-!R 2
H!R$ AND ,HEN E%ER& H!R -!R '2 H!R$1 -!R N!N ,-PA
*$"HE)*" $,R!#E PA,*EN,$, E%ER& 3 H!R$ -!R .3 H!R$ AND
,HEN E%ER& 4 H!R$1 -!R HE)!RRHA+*" $,R!#E ,NER!
"HE"#$ E*,HER E%ER& H!R -!R .3 H!R$ AND ,HEN "HE"#
W*,H NER!$R+E!N !R NER!5!+*$, -!R -R,HER !RDER$,
!R E%ER& 3 H!R$ ,HEN "HE"#1 %*,A5 $*+N$ ARE E%ER& H!R
-!R .3 H!R$ ,HEN "HE"# W*,H NER!5!+*$, !R NER!
$R+EA!N -!R -R,HER !RDER$1
Perform neurologi6al assessments and 7ital signs e7ery '( minutes during the
infusion of rtPA, and for . hours following 6om8letion of treatment, and then,
e7ery /0 minutes, thereafter, for the ne9t 2 hours and, then, e7ery hour until .3
hours after treatment1
-or non rtPA stro:e 8atients; Patient in *" - neuro assessment and 7ital
signs e7ery hour Patient on med-surg unit - neuro assessment and 7ital signs
e7ery 3 hour -re<uen6y 6an always =e in6reased =ased on 8atient 6ondition and
6hanges1 Neuro assessment entails the 6om8lete E)R neuro assessment in the
ongoing or admission forms1