| Description |
Intracranial hypertension (IH) is a neurological emergency that can lead to profound disability and death and is consequently referred to as a brain code. Intracranial hypertension is the sequelae of typical acute care diseases or injuries such as stroke, traumatic brain injuries (TBIs), and hepatic encephalopathy. The progression of IH to disability and death can be rapid, and the need to respond quickly in a methodical manner is imperative. The purpose of this Doctorate of Nursing Practice (DNP) project was to create an evidence-based guideline to streamline the care for this devastating event. By facilitating faster recognition and treatment, the quality of care for this patient population could dramatically improve. At a tertiary hospital in Salt Lake City, Utah, a standardized guideline for IH does not exist. This is a problem because it is a level-one trauma center and an advance comprehensive stroke center. Many patients with conditions that can trigger IH are frequently treated at this facility. The facility is a teaching hospital with interns, residents, and fellows who rotate through various specialties, floors, and units. It is unrealistic to expect these individuals to become and remain competent in the care of patients with this neurological emergency. Due to there being disagreements on managing IH, each provider approaches management differently. This further emphasized the need for a thorough literature review to ensure evidence-based recommendations were utilized. Four objectives were identified for this project. The primary objective was to create a brain code guideline to standardize how intracranial hypertension is recognized and managed at the tertiary hospital mentioned above. Secondly, the completed guideline was presented to neurocritical care providers for approval and/or revision. Thirdly, nursing staff outside specialty neurology floors were provided education on how to appropriately recognize and respond to intracranial hypertension. Lastly, the findings for this project were disseminated to a larger audience. Project implementation included developing the guideline and presenting it to key stakeholders. Feedback was received and necessary revisions were made. An IH presentation was given to nursing staff, and their understanding was evaluated with a multiple choice pre-and post-test. Those nurses were also asked to comment on the usability and feasibility of the guideline. Lastly, a clinical poster was accepted for presentation at the Ogden Surgical-Medical Society Conference in May. Standardization via clinical practice guidelines or protocols have resulted in increased efficiency, better patient outcomes, lower costs, and decreased morbidity and mortality. The best example of a neurology-specific guideline is a stroke alert protocol, which has been found to reduce both treatment time and time to computed tomography (CT). The treatment for IH includes but is not limited to hyperventilation, surgery, and ICP monitor placement and pharmacological interventions include hyperosmolar therapy, blood pressure management, and sedation. Brain codes are as serious as cardiac and respiratory arrests, which is precisely why this project was undertaken. The need to quickly recognize and effectively treat IH is imperative, because as eluded to above, it can lead to profound complications and potentially death. By having a guideline in place, the care for this neurologic emergency will become standardized. Future implications of this DNP project are piloting the guideline and validating its usefulness within a neurocritical care unit. |
