IV Thrombolytics
How do you know if IV Tenecteplase was considered for your patient?
This determination is made during the initial stroke consult. It can be found on the Neuro Stroke tab or in provider notes.
How do you know if your patient is eligible for mechanical thrombectomy?
There would be a target clot identified via CTA, and viable tissue via CTP. You would likely find this out from the Stroke team.
What bedside swallow screen tool do we use?
Rapid Aspiration Screen for Suspected Stroke (RAS³)
How do you ensure stroke core measures are met for your stroke patient?
Check the Red core measure sheet every day to make sure core measures are met. All of the nursing related core measures are listed. It is not a part of the medical record.
How often is stroke education for patients documented?
Once per shift.
What is the timeframe for IV Tenecteplase administration?
IV Thrombolytic therapy can be given to eligible patients within 3 hrs of LKW. In some cases, it can be given up to 4.5 hrs from LKW.
How frequently do you check VS/neuro checks/puncture site after mechanical thrombectomy?
Q 15 min X 2hrs
Q 30 min X 6 hrs
Q 60 min X 16 hrs
What do you do if your NPO stroke patient has orders for oral route medications?
Notify provider to get route changed (i.e. IV or via feeding tube). Patients who are NPO with a feeding tube should not have oral route medications documented in the MAR. A comment placed to correct the route is not appropriate; the order must be changed to reflect the correct route.
What are SMART format goals?
S: Specific
M: Measurable
A: Achievable
R: Relevant
T: Timely
Example SMART format goal: Patient will walk 1 full lap around 3ICU hallway 3X during dayshift to promote increased mobility.
Why are personal risk factors important and where do you document them?
The best way to prevent future strokes is to educate patients based on their personal risk factors for stroke. Teach them which risk factors are modifiable, and how to modify them. Document the risk factors that are appropriate to your patient on the Stroke Education template.
Who is eligible for IV Tenecteplase?
Inclusion/Exclusion criteria for IV Tenecteplase is located on the CDH Stroke Microsoft Teams site.
What are BP parameters post mechanical thrombectomy?
<180/105
Unless otherwise specified by a provider
What medications would you anticipate giving a HEMORRHAGIC stroke patient on anticoagulants?
Anticoagulation Reversals:
Coumadin---- Vitamin K, FFP & KCentra
Heparin--- Protamine Sulfate
Pradaxa----- Praxbind (specific reversal) and FEIBA
Eliquis----- Andexxa (specific reversal) and KCentra
Xarelto---- Andexxa (specific reversal) and KCentra
(AHA/ASA Clinical Practice Guidelines)
What does the modified rankin scale (mRS score) measure? When are you required to document it?
mRS is a functional status scale that measures the degree of disability. Use the algorithm on the back of the red core measure sheet to properly score the patient. The mRS needs to be documented for pre-admit (baseline status), admit (status at stroke symptom onset), and discharge (Discharge status). These incremental scales are used to track stroke patient outcomes.
What education do you receive for stroke care?
Annual Stroke Module in MyLearning, NIHSS every other year, Neurovascular Conferences, Unit specific education days
How do you administer IV Tenecteplase?
The IV Tenecteplase dose is calculated as 0.25mg/kg. Pharmacy reconstitutes IV Tenecteplase at CDH. It is given as a IV push over 5 seconds. The max dose of Tenecteplase for stroke treatment is 25mg.
If the patient had a Mechanical Thrombectomy, how do you know that it was successful?
Explanation of the intervention can be found in the provider post-op note. A Thrombolysis In Cerebral Infarction (TICI) score is documented in the post-op note. Desirable TICI scores are 2B, 2C or 3.
How frequently do you check VS/neuro checks/puncture site after angiogram/coiling/carotid stent? (Not CEA & TCAR)
Q 15 min X 1 hr
Q 30 min X 2 hrs
Q 60 min X 2 hrs
If ICU status: q 60 min X 19 hrs
If SD status: q 4 hr X 19 hrs
How do you know if a stroke order set was used for your patient?
Scroll to the bottom of the Neuro Stroke tab. It lists all order sets used during that hospital encounter.
How many hours of stroke specific education do you need every year?
Staff RN’s need 4 hrs annually (3ICU and CC Floats)
CSCs need 8 hrs annually (2ICU, 3ICU, and CICU)
What are the two most common adverse effects of IV Tenecteplase?
Bleeding (watch for signs of hemorrhagic conversion)
Angioedema
Why was the Stroke Alert window expanded to LKW within 24 hrs in 2018?
The AHA/ASA Clinical Practice Guidelines were updated in Jan. 2018. They now state that it is beneficial to do mechanical thrombectomy up to 24 hrs from LKW for certain eligible patients. CDH expanded the window to capture this population.
What is documented post-TCAR or CEA? What frequency are these items documented?
Vital Signs, Neuro Check, Cranial Nerves
Q15min X 1 hr
Q30 min X 2 hrs
Q60min X 21 hours
Where do you find documentation of “Last Known Well (LKW)”?
LKW is documented during the initial stroke consult. It can be found on the Neuro Stroke tab or in provider notes.
What is the difference between Clinical Practice Guidelines and Clinical Pathways?
Clinical Practice Guidelines are journal articles published by the AHA/ASA. All of our stroke related policies and procedures are formed out of the Clinical Practice Guidelines.
The Clinical Pathways are internal documents that take the info in the Clinical Practice Guidelines, and put it in a more readable/useable format. They are in a table format, and a great reference for daily stroke care. Both are located on the CDH Stroke team site.