Implementation of a Standardized Neurological Assessment Protocol to Reduce Delayed Recognition of Neurological Deterioration in a Neuro ICU
Advisor(s)
Megan Lieb
Confirmation
1
Document Type
Poster
Location
ONU McIntosh Center; Activities Room
Start Date
24-4-2026 11:00 AM
End Date
24-4-2026 11:50 AM
Abstract
Abstract
Problem: Delayed recognition of neurological deterioration in adult neurocritical care patients contributes to increased morbidity, mortality, and prolonged hospitalization. Inconsistent neurological assessment frequency and documentation practices in the Neuro Intensive Care Unit (Neuro ICU) may delay identification of clinically significant changes in neurological status.
Purpose: The purpose of this project is to evaluate whether implementing a standardized neurological assessment protocol utilizing the Glasgow Coma Scale (GCS) and scheduled pupil checks every two hours in an adult Neuro ICU reduces delayed recognition of neurological deterioration compared to pre-implementation assessment practices.
Methods: This quality improvement project will use a quantitative pre- and post-implementation design in an adult Neuro ICU. Adult patients requiring neurological monitoring will be included. Baseline data will be collected retrospectively to evaluate assessment frequency, documentation accuracy, and time to recognition. The intervention will implement a standardized protocol requiring nurses to perform and document neurological assessments every two hours using the GCS and pupillary checks, with defined escalation criteria and staff education. Chart review will be used to determine delayed recognition, defined as a greater than 2-point decrease in GCS or new abnormal pupil finding without provider notification within 30 minutes. Data from the 6 months prior to the intervention will be compared to data from the 6 months following intervention.
Conclusion: Implementation of a standardized neurological assessment protocol is expected to improve monitoring consistency and reduce delays in recognizing neurological deterioration. Earlier identification of neurological decline can support timely intervention, improve interdisciplinary communication, and enhance patient safety. This project has the potential to strengthen evidence-based nursing practice.
Recommended Citation
Knick, Hailey R., "Implementation of a Standardized Neurological Assessment Protocol to Reduce Delayed Recognition of Neurological Deterioration in a Neuro ICU" (2026). ONU Student Research Colloquium. 49.
https://digitalcommons.onu.edu/student_research_colloquium/2026/Posters/49
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Implementation of a Standardized Neurological Assessment Protocol to Reduce Delayed Recognition of Neurological Deterioration in a Neuro ICU
ONU McIntosh Center; Activities Room
Abstract
Problem: Delayed recognition of neurological deterioration in adult neurocritical care patients contributes to increased morbidity, mortality, and prolonged hospitalization. Inconsistent neurological assessment frequency and documentation practices in the Neuro Intensive Care Unit (Neuro ICU) may delay identification of clinically significant changes in neurological status.
Purpose: The purpose of this project is to evaluate whether implementing a standardized neurological assessment protocol utilizing the Glasgow Coma Scale (GCS) and scheduled pupil checks every two hours in an adult Neuro ICU reduces delayed recognition of neurological deterioration compared to pre-implementation assessment practices.
Methods: This quality improvement project will use a quantitative pre- and post-implementation design in an adult Neuro ICU. Adult patients requiring neurological monitoring will be included. Baseline data will be collected retrospectively to evaluate assessment frequency, documentation accuracy, and time to recognition. The intervention will implement a standardized protocol requiring nurses to perform and document neurological assessments every two hours using the GCS and pupillary checks, with defined escalation criteria and staff education. Chart review will be used to determine delayed recognition, defined as a greater than 2-point decrease in GCS or new abnormal pupil finding without provider notification within 30 minutes. Data from the 6 months prior to the intervention will be compared to data from the 6 months following intervention.
Conclusion: Implementation of a standardized neurological assessment protocol is expected to improve monitoring consistency and reduce delays in recognizing neurological deterioration. Earlier identification of neurological decline can support timely intervention, improve interdisciplinary communication, and enhance patient safety. This project has the potential to strengthen evidence-based nursing practice.