Abstract
Background and Purpose: Stroke is the second leading cause of death and the third leading cause of death and disability combined worldwide. Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (tPA) or Tenecteplase (TNK) remains the standard treatment for ischemic stroke. While life-saving, IVT carries risks such as symptomatic intracranial hemorrhage and orolingual angioedema, occurring in 1.3–5.1% of patients (Rodgers et al., 2021). Nurses play a pivotal role in post-IVT care (You Zhang et al., 2024), where timely neurological monitoring is essential for early complication detection (Faigle et al., 2020). Guidelines mandate assessments every 15 minutes for 2 hours, every 30 minutes for 6 hours, and hourly for 16 hours (Feigin et al., 2025). However, audits in a 22-bed critical care unit revealed documentation lapses, particularly for angioedema and bleeding, often during shift changes and transfers. This nurse-driven quality improvement (QI) project aimed to develop a compliance tool to improve accuracy and consistency in post-IVT documentation, ensuring patient safety and adherence to Joint Commission Advanced Stroke Certification standards (Waldman et al., 2023).
Methods: After missed documentation was identified in three patients, the Plan-Do-Study-Act (PDSA) framework guided interventions, with a goal of 100% compliance by December 2022. Baseline data were collected from Dec 2021–Feb 2022. Initial improvements included email alerts for IVT patients to flag monitoring needs. In March 2022, a revised Post-IVT Checklist Tool was introduced, featuring prefilled time columns for required assessments. The tool was initiated in the ED and transferred with patients to critical care, ensuring continuity. Nurses were supported with positive reinforcement and real time coaching.
Results: Between March–October 2022, 48 charts were audited. Documentation of angioedema and bleeding assessments improved from 50% in March to 100% in October, achieving the QI goal within seven months.
Conclusion and Implications for Practice: A nurse-driven visual checklist, reinforced by structured auditing and positive feedback, significantly improved adherence to post-IVT monitoring protocols directly improving patient outcomes. This initiative supports maintenance of Joint Commission Advanced Stroke Certification and the physical checklist acts as a standardized communication bridge between the ED and Critical Care, improving continuity of care.
Notes
References:
Faigle, R., Butler, J., Carhuapoma, J. R., Johnson, B., Zink, E. K., Shakes, T., Rosenblum, M., Saheed, M., & Urrutia, V. C. (2020). Safety trial of low-intensity monitoring after thrombolysis: Optimal post tPA-IV monitoring in ischemic stroke (OPTIMIST). The Neurohospitalist, 10(1), 11–15. https://doi.org/10.1177/1941874419845229
Feigin, V. L., Brainin, M., Norrving, B., Martins, S. O., Pandian, J., Lindsay, P., Grupper, M. F., & Rautalin, I. (2025). World Stroke Organization: Global stroke fact sheet 2025. International Journal of Stroke, 20(2), 132–144. https://doi.org/10.1177/17474930241308142
Rodgers, M. L., Fox, E., Abdelhak, T., Franker, L. M., Johnson, B. J., Kirchner-Sullivan, C., Livesay, S. L., Marden, F. A., & on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing and the Stroke Council. (2021). Care of the patient with acute ischemic stroke (endovascular/intensive care unit-postinterventional therapy): Update to 2009 comprehensive nursing care scientific statement: A scientific statement from the American Heart Association. Stroke, 52(5), https://doi.org/10.1161/STR.0000000000000358
Waldman, A., Tadi, P., Khan, S. M. Z., & others. (2024). Stroke center certification. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535392/
Zhang, Y., Tang, Y.-W., Peng, Y.-T., Yan, Z., Zhou, J., & Yue, Z.-H. (2024). Acupuncture, an effective treatment for post-stroke neurologic dysfunction. Brain Research Bulletin, 215, 111035. https://doi.org/10.1016/j.brainresbull.2024.111035
Sigma Membership
Chi Alpha at-Large, Eta Beta
Type
Poster
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Acute Care, Interprofessional and Interdisciplinary, Implementation Science, Ischemic Stroke, Documentation, Quality Control
Recommended Citation
Abba, Kafayat; Brereton, Charmaine; Alte, Maria; Cadore, Lysta; Bernadotte, Damali; White, Nydia; and DeMelis, Katherine, "Improving Post-Thrombolysis Assessment and Documentation Compliance in Acute Ischemic Stroke Care" (2026). International Nursing Research Congress (INRC). 82.
https://www.sigmarepository.org/inrc/2026/posters_2026/82
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-27
Improving Post-Thrombolysis Assessment and Documentation Compliance in Acute Ischemic Stroke Care
Toronto, Ontario, Canada
Background and Purpose: Stroke is the second leading cause of death and the third leading cause of death and disability combined worldwide. Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (tPA) or Tenecteplase (TNK) remains the standard treatment for ischemic stroke. While life-saving, IVT carries risks such as symptomatic intracranial hemorrhage and orolingual angioedema, occurring in 1.3–5.1% of patients (Rodgers et al., 2021). Nurses play a pivotal role in post-IVT care (You Zhang et al., 2024), where timely neurological monitoring is essential for early complication detection (Faigle et al., 2020). Guidelines mandate assessments every 15 minutes for 2 hours, every 30 minutes for 6 hours, and hourly for 16 hours (Feigin et al., 2025). However, audits in a 22-bed critical care unit revealed documentation lapses, particularly for angioedema and bleeding, often during shift changes and transfers. This nurse-driven quality improvement (QI) project aimed to develop a compliance tool to improve accuracy and consistency in post-IVT documentation, ensuring patient safety and adherence to Joint Commission Advanced Stroke Certification standards (Waldman et al., 2023).
Methods: After missed documentation was identified in three patients, the Plan-Do-Study-Act (PDSA) framework guided interventions, with a goal of 100% compliance by December 2022. Baseline data were collected from Dec 2021–Feb 2022. Initial improvements included email alerts for IVT patients to flag monitoring needs. In March 2022, a revised Post-IVT Checklist Tool was introduced, featuring prefilled time columns for required assessments. The tool was initiated in the ED and transferred with patients to critical care, ensuring continuity. Nurses were supported with positive reinforcement and real time coaching.
Results: Between March–October 2022, 48 charts were audited. Documentation of angioedema and bleeding assessments improved from 50% in March to 100% in October, achieving the QI goal within seven months.
Conclusion and Implications for Practice: A nurse-driven visual checklist, reinforced by structured auditing and positive feedback, significantly improved adherence to post-IVT monitoring protocols directly improving patient outcomes. This initiative supports maintenance of Joint Commission Advanced Stroke Certification and the physical checklist acts as a standardized communication bridge between the ED and Critical Care, improving continuity of care.
Description
This quality improvement project aimed to enhance compliance with post-thrombolysis assessment and documentation in acute ischemic stroke care. A baseline audit revealed gaps in recording neurological status, vital signs, and bleeding complications. Interventions included staff education and creation of a standardized template. Post-intervention audits demonstrated improved documentation adherence, supporting safer, more consistent stroke management practices.