Implementing clinical guidelines for acute stroke management : Do nurses have a lead role?

Objective: Health professionals should be aware of, and implement, best practice clinical guidelines for stroke care. Using the latest National Stroke Foundation Clinical Guidelines for Acute Stroke Management this study aimed to determine which member of the multidisciplinary team would most likely be responsible for taking the lead role for implementing each recommendation.

Methods: Three nurses and one allied health professional independently classified each of the 148 recommendations according to whom they thought most likely to take the lead role in implementing each recommendation. A teleconference was held to discuss any differences of opinion and gain consensus.

Results: The multidisciplinary team was identified as responsible for taking the lead role most often (n=54, 36%), followed by medical practitioners (n=52, 35%) and nurses (n=13, 8%). Nurses were identified as being involved either as the lead initiator or as part of the multidisciplinary team in implementing 79 (53%) of recommendations. A significantly higher percentage of recommendations where implementation was determined to be led by medical practitioners were attributed a Grade A or B strength of evidence (ie higher strength) (49%) when compared with those recommendations determined to be led by nurses (6%) (p=0.04). There was no significant difference between the number of Level I or II based recommendations determined to be led by medical practitioners compared to those led by nurses (59%; 11% respectively; p=0.26).

Conclusions: Neuroscience nurses have a key role in the multidisciplinary stroke team and should contribute to the implementation of many of the evidence based guideline recommendations for acute stroke.