Abstract P821: A New Era for Cerebral Angiograms: TransRadial Approach in NeuroInterventional Radiology

Background: Historically, femoral artery access has been the standard for neurointerventional radiology (NIR) procedures. However, recent advances in cerebral angiography have resulted in new arterial access locations, such as the TransRadial (TR) approach which has become more frequently utilized by proceduralists at our facility. This change necessitates staff competency when caring for TR-approach patients. In 2019, our facility received a recommendation for improvement (RFI) from The Joint Commission during the Comprehensive Stroke Center recertification survey related to incomplete post-TR-approach documentation. Upon initiation of TR-approach documentation audits, the team discovered documentation compliance rates of 46.2% for both TR wristband deflation volumes and wristband removal. Purpose: Due to the lack of knowledge associated with the novel TR-approach, the purpose of this project was to standardize post-NIR nursing care for patients who underwent a TR-approach cerebral angiogram. The goal was to observe a 25% increase in TR-approach care documentation elements by January 2020. Methods: Education created by the NIR manager was shared with nursing leadership and bedside nursing staff. Audits completed by the stroke quality nurse and NIR manager immediately followed to measure compliance with documentation of TR wristband deflation volumes and wristband removal. The NIR team collaborated with informatics leadership to develop a NIR documentation band within our electronic documentation system, resulting in a centralized location for documentation of all required TR-approach details. The two items specifically lacking compliance were included in the NIR documentation band build. Results: Audits demonstrated a 28.4% increase in compliance of TR wristband removal documentation and an 18.6% increase in compliance in TR wristband deflation protocol documentation. Conclusion: As a result of the RFI, our facility developed a protocol for post-TR-approach nursing care that can ultimately improve patient safety and outcomes, as well as be easily replicated at other facilities seeking to improve NIR patient care.