Nursing-driven Acute Stroke Care (NAS-Care) is the first project to be carried out as part of the Lone Star Stroke Consortium. NAS-Care is a quality improvement project that aims to improve stroke care throughout the state of Texas. NAS-Care was piloted in the Fall of 2013 at UT Southwestern Medical Center as Quality Care Improvement with Nursing-driven Acute Stroke Care (QCI-NASCAR). NAS-Care is built on five key principles:
- Identification of Shared Goals
- Organized Urgency with the Removal of Gatekeepers
- Multi-personnel, Non-Sequential Processes
- Focus on Defined Staged Roles and Tasks
- Empowered Engagement, Empowered Responsibility
These principles are taught and promoted as part of the “core curriculum” for the NAS-Care protocol. During protocol implementation, emergency department (ED) personnel are alerted to how the NAS-Care workflow processes are designed to reflect these principles. Although medical decision-making ultimately lies with physicians (both ED and stroke specialists), this protocol purposefully de-emphasizes the role of physicians and providers as gatekeepers of each step of the acute stroke code process.
The goal of NAS-Care is to empower ED nurses to be engaged leaders in the stroke code process. Part of this empowerment involves the nursing staff activating stroke codes, performing standing orders, and working in parallel to quickly and efficiently accomplish a common goal – to gather all information needed to make a tPA decision as quickly as possible.