Date
10-16-2025
Department
School of Nursing
Degree
Doctor of Nursing Practice (DNP)
Chair
Candi M. Payne
Keywords
code stroke protocol, Epic Stroke Narrator, inpatient stroke, last known well time, stroke documentation, inpatient code stroke, ip code stroke
Disciplines
Neuroscience and Neurobiology | Nursing
Recommended Citation
Carter, Stacy L., "Pilot Study: Integrating the Epic Stroke Narrator into Inpatient Code Stroke Protocols to Improve Symptom Onset Identification and Reduce Intervention Times" (2025). Doctoral Dissertations and Projects. 7558.
https://digitalcommons.liberty.edu/doctoral/7558
Abstract
In-hospital strokes are often underrecognized, leading to treatment delays and poorer outcomes compared to community-onset strokes. This scholarly project evaluated whether integrating the Epic Stroke Narrator into inpatient code stroke protocols could improve documentation of last known well time (LKWT) and reduce time to intervention. A 6-week quasi-experimental pilot study guided by the Iowa Model of Evidence-Based Practice and Rogers’ diffusion of innovations theory was conducted on a neuroscience telemetry step-down unit at a comprehensive stroke center in Richmond, Virginia. Education on the Stroke Narrator was provided to bedside nurses and was followed by implementation and evaluation of narrator use during inpatient stroke events. A retrospective chart review revealed that during the preimplementation period, LKWT was documented in only 10% of cases, and 3.3% of patients received intervention within 60 minutes. Postimplementation, narrator use was 91%, with LKWT documented in 91% of cases and 27.3% of patients receiving timely intervention. The difference in LKWT documentation was statistically significant (p = .0000), while the increase in timely intervention rates approached significance (p = .0521). Qualitative feedback from nursing staff indicated high satisfaction and perceived usability of the tool. These findings suggest that use of the Epic Stroke Narrator significantly improves documentation and may reduce delays in care. Integrating standardized tools into stroke response workflows strengthens nursing practice, supports guideline compliance, and improves the facility's readiness for comprehensive stroke certification. Broader adoption and ongoing staff education may support long-term sustainability and improved outcomes for hospitalized stroke patients.
