Abstract
Background: Nursing neurologic assessments are essential for timely recognition and escalation of changes in neurologic status (1-3). However, nursing neurologic assessments lacked standardization on a 51-bed pediatric oncology and bone marrow transplant unit. Approximately 40% of emergency transfers (4) over three years were related to neurologic changes and nurses lacked confidence in performing neurologic assessments.
Purpose: The purpose of this quality improvement project was to standardize the process for nursing neurologic assessments, with aims to: 1) increase nurses’ confidence in performing neurologic assessments and 2) decrease emergency transfers related to changes in neurologic status.
Methods: The Serial Neurologic Assessment in Pediatrics (SNAP) tool (5) was implemented as the unit's standard of care nursing neurologic assessment in August 2023. A five-question survey of nurses’ self-reported confidence was completed at four timepoints. Questions were designed on a Likert scale, with scores ranging from 1 (not confident) to 5 (completely confident). An independent t-test compared scores at different timepoints. Scores of 4 and 5 were grouped as ‘confident’ in summary analysis.
Emergency transfers were identified through existing hospital systems and chart review identified events with neurologic changes. Documentation compliance was measured to assess tool adoption and identify if implementation unintentionally introduced disparities.
Outcomes: A statistically significant increase in nurses’ confidence was observed from baseline to post-implementation (p<0.0001). Prior to education, 58% of nurses reported confidence around neurologic assessments (n=116), increasing to 87% post-implementation (n=91), 89% 6-months post-implementation (n=114), and 89% 2-years post-implementation (n=121). There was a 58% reduction in rate of emergency transfer for neurologic change in the two years following SNAP implementation, and 76% of nurses reported that SNAP played a key role in their identification of a patient’s neurologic change. Documentation compliance was 81%, and there was no difference in documentation by patient race, ethnicity, language, or payor group.
Discussion: SNAP was successfully implemented on an inpatient pediatric oncology unit, standardizing the nursing neurologic assessment, promoting early recognition of neurologic changes, sustainably increasing nurses’ confidence and decreasing emergency transfers related to changes in neurologic status.
Notes
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References:
1. Cartwright, C., Battick, K., Coffman, J., Crespo, Y., Fagan, C., & Szego, S. (2023). Neurological assessment of the hospitalized child [White paper]. American Association of Neuroscience Nurses. https://aann.org/uploads/about/AANN23_Neuro_Pediatric_White_Paper_062823_final.pdf
2. Greenshields, S. (2019). Neurological assessment in children and young people. British Journal of Nursing, 28(16), 1056-1059. https://doi.org/10.12968/bjon.2019.28.16.1056
3. Mushta, J., Rush, K. L., & Andersen, E. (2017). Failure to rescue as a nurse-sensitive indicator. Nursing Forum, 53(1), 84-92. https://doi.org/10.1111/nuf.12215
4. Hussain, F. S., Sosa, T., Ambroggio, L., Gallagher, R., & Brady, P. W. (2019). Emergency transfers: An important predictor of adverse outcomes in hospitalized children. Journal of Hospital Medicine, 14(8), 482-485. https://doi.org/10.12788/jhm.3219
5. Kirschen, M.P., Smith, K.A., Snyder, M., Zhang, B., Flibotte, J., Heimall, L., Budznski, K., DeLeo, R., Cona, J., Bocage, C., Hur, L., Winters, M., Hanna, R., Mensinger, J.L., Huh, J., Lang, S-S., Barg, F.K., Shea, J.A., Ichord, R., Berg, R.A., Levine, J.M., Nadkarni, V., & Topjian, A. (2021). Serial neurologic assessment in pediatrics (SNAP): A new tool for bedside neurological assessment of critically ill children. Pediatric Critical Care Medicine, 22(5), 483-495. https://doi.org/10.1097/PCC.0000000000002675
Sigma Membership
Beta Xi at-Large, Nu Beta at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Advancing Clinical Practice, Acute Care, Implementation Science, Competence, Neurologic Examination, Pediatric Oncology Nursing
Recommended Citation
Smith, Katherine; McWhorter, Jessica; Gliddon, Cara; Poloskey, Barbara; Mehta, Sanjiv; and DiGerolamo, Kimberly, "SNAP Into Action: Standardizing Nursing Neurologic Assessments in Pediatric Oncology" (2026). International Nursing Research Congress (INRC). 232.
https://www.sigmarepository.org/inrc/2026/presentations_2026/232
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
SNAP Into Action: Standardizing Nursing Neurologic Assessments in Pediatric Oncology
Toronto, Ontario, Canada
Background: Nursing neurologic assessments are essential for timely recognition and escalation of changes in neurologic status (1-3). However, nursing neurologic assessments lacked standardization on a 51-bed pediatric oncology and bone marrow transplant unit. Approximately 40% of emergency transfers (4) over three years were related to neurologic changes and nurses lacked confidence in performing neurologic assessments.
Purpose: The purpose of this quality improvement project was to standardize the process for nursing neurologic assessments, with aims to: 1) increase nurses’ confidence in performing neurologic assessments and 2) decrease emergency transfers related to changes in neurologic status.
Methods: The Serial Neurologic Assessment in Pediatrics (SNAP) tool (5) was implemented as the unit's standard of care nursing neurologic assessment in August 2023. A five-question survey of nurses’ self-reported confidence was completed at four timepoints. Questions were designed on a Likert scale, with scores ranging from 1 (not confident) to 5 (completely confident). An independent t-test compared scores at different timepoints. Scores of 4 and 5 were grouped as ‘confident’ in summary analysis.
Emergency transfers were identified through existing hospital systems and chart review identified events with neurologic changes. Documentation compliance was measured to assess tool adoption and identify if implementation unintentionally introduced disparities.
Outcomes: A statistically significant increase in nurses’ confidence was observed from baseline to post-implementation (p<0.0001). Prior to education, 58% of nurses reported confidence around neurologic assessments (n=116), increasing to 87% post-implementation (n=91), 89% 6-months post-implementation (n=114), and 89% 2-years post-implementation (n=121). There was a 58% reduction in rate of emergency transfer for neurologic change in the two years following SNAP implementation, and 76% of nurses reported that SNAP played a key role in their identification of a patient’s neurologic change. Documentation compliance was 81%, and there was no difference in documentation by patient race, ethnicity, language, or payor group.
Discussion: SNAP was successfully implemented on an inpatient pediatric oncology unit, standardizing the nursing neurologic assessment, promoting early recognition of neurologic changes, sustainably increasing nurses’ confidence and decreasing emergency transfers related to changes in neurologic status.
Description
The Serial Neurologic Assessment in Pediatrics tool was implemented as the standard of care nursing neurologic assessment on a 51-bed pediatric oncology and bone marrow transplant unit in August 2023. In the two years following implementation, there was a significant increase in nurses’ self-reported confidence (58% to 89%, p<0.0001) and a 58% reduction in rate of emergency transfers related to neurologic changes.