Alerts
What number do you call to report Code Stroke
8-2222
How often do you monitor VS and Neuro post TNK?
Q15 min for 2 hrs
Q30 min for 6 hrs
Q1 hr for 16 hrs
What assessment tools does your organization use to assess stroke patients?
NIHHS, certify every year
If patient goes to IR, describe the process?
Stroke Team calls IR team and if accepted a code neuro is activated and patient goes to ADC
Describe how stroke data is regularly shared with the ED staff?
Stand Up/Huddle
Newsletter
Stroke Kudos Board
Staff meetings
Who can call Stroke Alert?
Nurse, Physician, EMS
How do you manage TNK complications if they occur?
Notify stroke team, ED physicians, ABC's, Stat CT
Where are the stroke protocols?
Infonet-Stroke Center
How is the plan of care communicated to the patient and or family?
MD discuss treatment decisions with family/patient. Nurse reinforces information that was given and informs patient/family of any treatment changes.
What is your average door to TNK time?
73 minutes
What triggers the endovascular team to be notified?
Positive for LVO
How often you monitor Vs and Neuro on SAH,ICH?
Q4 hrs neuro checks and Q2 hr VS
What is the ED doing to improve the care of stroke patients?
Decrease patient to CT time so that TNK is not delayed. Decrease time to the ADC do decrease door to puncture time.
How does EMS notify you of possible stroke patient?
EMS calls radio room/Pulsara
Average door to CT time?
14 minutes
Describe how the neurosurgery team is notified of a hemorrhagic stroke patient?
NSGY Consult/Code Neuro is paged
When would you administer TNK?
Once the order has been entered into the EMR.
Are you certified in the use of NIHSS and what does it tell you?
Yes
The severity of the stroke, the higher the score, the greater the deficitrs.
What criteria does your program use to call the stroke team? Time...
Last known well within 6 hours.
What are the expected time lines?
Door to CT
Lab Results
Door to tPA
Door to CT <15 min
Labs result <30min
Door to tPA <45 min
What triggers the NSGY team to be consulted?
Evaluation of ICH, IVH, SAH
How often do you monitor VS on acute ischemic stroke patient waiting for treatment decision?
Initial baseline.
with treatment: follow TNK protocol, if not treated with TNK, then Q4 hrs or more often if needed.
What are the stroke core measures currently being monitored that applies to the ED?
TNK documentation
Dysphagia screen compliance
Stroke Alert metrics
ASA by EOD 2
Describe the process of handoff between shifts, between EMS and ED and between ED and IR?
Shift: RN to RN
EMS: bedside to RN and providers
ED to IR: RN to IR RN/MD bedside report
Describe PI areas the ED has worked on?
Dysphagia screens
TNK documentation
Reviewing fallouts
Improve lab turnaroud times