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Stroke Alert at Lutheran General Hospital, Park Ridge, IL - PowerPoint PPT Presentation


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Lynn Michel, RN, MSN, APN / CNS. Stroke Alert at Lutheran General Hospital, Park Ridge, IL. Stroke Alert. Stroke Alert started on 01/01/07 700 bed suburban teaching hospital Level I Trauma Center. Emergency room Patient triaged as priority 3 or 4 / 5

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Presentation Transcript
stroke alert
Stroke Alert
  • Stroke Alert started on 01/01/07
  • 700 bed suburban teaching hospital
  • Level I Trauma Center
pre stroke alert
Emergency room

Patient triaged as priority 3 or 4 / 5

CT ordered along with other “stat” ER orders

In-House patients

Physician notified of patients change in condition

CT if ordered was ordered “stat”

Neurology consult if ordered

Pre-Stroke Alert
why do a stroke alert
Why do a Stroke Alert?
  • As a Primary Stroke Center we wanted to have a process in place to:
    • Expedite the assessment and treatment of patients experiencing stroke symptoms.
    • To decrease the “Door to CT time” to 25 minutes or less for ER and inpatients experiencing stroke symptoms less than 3 hours in duration
why is a stroke alert important
Why is a Stroke Alert important?
  • tPA can reverse an Acute Ischemic Stroke but must be given within 3 hours of symptom onset
    • Interventional procedures now available
  • Hemorrhagic stroke is also an emergency and may require surgical intervention.
hemorrhagic stroke
Hemorrhagic Stroke
  • 10-15% of all strokes… 37,000 to 52,400 new cases / year
  • Incidence: 15 per 100,000 individuals / year
  • Rate expected to double by 2050
  • African-American and Japanese: incidence is twofold than in Caucasians
  • 35 to 52% 1 month mortality
  • Only 20% were living independently by 6 months
the beginning 6 months prior to starting
The beginning….6 months prior to starting
  • Stroke Coordinator
  • Stroke Team Neurologist
  • ED Medical Director
  • Critical care director
  • Hospital Operator
stroke alert8
Stroke Alert
  • Based on the “Code Yellow” and “Cath Lab Alert”
  • We chose to call it “Stroke Alert” and not another “coded name”
  • This increases awareness to staff and lay people that stroke is an emergency
what we needed
What we needed:
  • Provide rapid diagnosis and treatment of stroke. (RRT for inpatients)
  • Written protocols (time frame) for assessment and treatment. (RRT)
      • CT to get a scanner prepared
      • tPA if appropriate (tPA on call list)
      • Neuro-Surgery if appropriate
nursing considerations
Nursing Considerations
  • Call x 213333 and report that you have a “Stroke Alert”
  • The operator will page
  • “Stroke Alert…and unit name”
  • or “Stroke Alert…ER”
  • RRT will be paged and respond to in-house strokes
nursing considerations11
Nursing considerations
  • CT department will get a CT scanner ready for the patient.
  • Nurse can call RRT first who then will assess and call the “Stroke Alert”
how many
196 stroke alerts in 2007

1st quarter of 2007

57

1st quarter of 2008

53

How many?
lessons learned
Lessons learned
  • Pharmacy became involved to start the tPA checklist
  • There was “over calling” in the beginning
  • Need to orient new personnel
  • Need to change time criteria to reflect IA tPA and research study time frames
barriers 1 year out
MYTHS:

Physicians and nurses believe that Stroke Alert is only for those patients who qualify for tPA

TRUTH

10-15% of all strokes are hemorrhagic which also need emergency treatment

LGH has a stroke research project for ischemic stroke patients who don’t qualify for tPA

Barriers 1 year out