“Never Lose Your Nerve”: Standardizing Perioperative Cranial Nerve Assessments Using a Neuro Tool Box

Background Information

In the perioperative setting, patients undergoing craniotomies require thorough baseline neurological exams. Exams are repeated frequently in the postoperative phase of care and are valuable to recognize early signs of deviations. Our nurses occasionally expressed hesitancy in caring for this patient population due to the perceived complexity of the assessments and their lack of competency and confidence level. A staff survey showed up to 26% of nurses felt unsure about different knowledge-based questions. When measuring confidence level, 67% of staff lacked confidence in their assessment skills. Furthermore, survey data showed variable, inconsistent assessment practices.

Objectives of Project

To provide a standardized process and tools to perform congruent perioperative neurological assessments. To improve the quality of care and patient safety by hastening the identification and early intervention of neuro changes. To increase nursing knowledge and confidence levels in their neuro assessments.

Process of Implementation

We partnered with perioperative leadership and educators to collaborate on the concept of a standardized kit and development of a “Neuro Toolbox.” We surveyed staff to assess nursing knowledge. A kit was created containing evidence-based tools to assess patients consistently. Educational references were included to allow for staff review. We distributed boxes to each unit and coordinated in-services to educate staff on the toolbox. We performed ongoing reminders of this resource through emails and unit huddles.

Statement of Successful Practice

This standardized practice promotes high quality care of our craniotomy patients by providing safe and consistent care. Nurses have shared positive post-implementation feedback and we have seen high utilization of the toolbox, especially among newer staff. It is now being used as a tool for standard practice in our unit. Requests were made to expand the Neuro Toolbox to other units.

Implication for Advancing the Practice of PeriAnesthesia Nursing

The neuro tool kit is an example of how a collaborative, innovative, and standardized approach to our current practice helped nurture growth, education and foster confidence in our perioperative nurses while caring for this highly specialized patient population. Furthermore, promoting accountability, safety and optimizing patient outcomes.