2.50
Hdl Handle:
http://hdl.handle.net/10755/157116
Category:
Abstract
Type:
Presentation
Title:
Time is Brain - Rapid Response Team for Acute In-Hospital Strokes
Author(s):
Hewett, Mary; Mastrolia, Deborah; Lepman, Debbie
Author Details:
Mary Hewett, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA, email: mhewett@HoagHospital.org; Deborah Mastrolia; Debbie Lepman
Abstract:
PURPOSE: Stroke is a medical emergency. It is the #3 cause of death and leading cause of adult disability. The treatment goal is to reperfuse ischemic brain tissue. Unlike the response for cardiac arrest, most hospitals have no system for rapid intervention if a patient has a stroke in the hospital. This results in delayed neuro imaging, lab results and thrombolytic interventions, resulting in poorer patient outcomes. An in-hospital Code for stroke was initiated with the help of the Rapid Response team. Description: The first step in treating a stroke is rapid assessment and brain imaging. There is a 3 hour window of opportunity for IV thrombolytic therapy and 8 hours for Intra-arterial techniques. All staff RNs were educated to use the FAST test if they suspected a patient of having a stroke. The RN calls for the Rapid Response Team (RRT). The RRT nurse is a critical care nurse who has completed a stroke class and IV tPA competency. The RRT nurse will assess the patient and establish the time "the patient was last seen normal." If that time is less than 8 hours they will call a Code 20.This pages Stroke Team, which provides a Neurologist and alerts CT staff of the need for a Stat Code 20 CT scan. The Stroke Unit Charge nurse and another critical care nurse are also paged to the bedside. The Stroke protocol is initiated. The head of bed is put flat. Two IVs are started and a normal saline bolus is given, vital signs and NIH Stroke Scale are performed, labs drawn and BP maintained less than 220/110. The patient is transported to CT with a goal time of 20 minutes. The RRT nurse will discuss treatment plan with the neurologist and transfer patient to appropriate level of care where thrombolytics can be facilitated quickly if needed. EVALUATION: Hoag's Rapid Response Team/Code 20 process started 6 months ago. There have been 40 Codes called. 14 calls were cancelled due to time or seizure. Of the remaining 26 patients, 28% had ischemic strokes, 19% TIAs, 15% seizures, 34% other and 4% ICH. One patient was treated with IV tPA and returned to home functioning at a normal baseline. Average transport to CT time is 25 minutes. This equals the national benchmark for Door to CT time for ER stroke patients. Code 20 gives the RRT nurse an effective tool to use for suspected in-hospital stroke. It allows quicker brain imaging, lab results and treatment decisions leading to improved quality patient care and patient outcomes.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleTime is Brain - Rapid Response Team for Acute In-Hospital Strokesen_GB
dc.contributor.authorHewett, Maryen_GB
dc.contributor.authorMastrolia, Deborahen_GB
dc.contributor.authorLepman, Debbieen_GB
dc.author.detailsMary Hewett, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA, email: mhewett@HoagHospital.org; Deborah Mastrolia; Debbie Lepmanen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157116-
dc.description.abstractPURPOSE: Stroke is a medical emergency. It is the #3 cause of death and leading cause of adult disability. The treatment goal is to reperfuse ischemic brain tissue. Unlike the response for cardiac arrest, most hospitals have no system for rapid intervention if a patient has a stroke in the hospital. This results in delayed neuro imaging, lab results and thrombolytic interventions, resulting in poorer patient outcomes. An in-hospital Code for stroke was initiated with the help of the Rapid Response team. Description: The first step in treating a stroke is rapid assessment and brain imaging. There is a 3 hour window of opportunity for IV thrombolytic therapy and 8 hours for Intra-arterial techniques. All staff RNs were educated to use the FAST test if they suspected a patient of having a stroke. The RN calls for the Rapid Response Team (RRT). The RRT nurse is a critical care nurse who has completed a stroke class and IV tPA competency. The RRT nurse will assess the patient and establish the time "the patient was last seen normal." If that time is less than 8 hours they will call a Code 20.This pages Stroke Team, which provides a Neurologist and alerts CT staff of the need for a Stat Code 20 CT scan. The Stroke Unit Charge nurse and another critical care nurse are also paged to the bedside. The Stroke protocol is initiated. The head of bed is put flat. Two IVs are started and a normal saline bolus is given, vital signs and NIH Stroke Scale are performed, labs drawn and BP maintained less than 220/110. The patient is transported to CT with a goal time of 20 minutes. The RRT nurse will discuss treatment plan with the neurologist and transfer patient to appropriate level of care where thrombolytics can be facilitated quickly if needed. EVALUATION: Hoag's Rapid Response Team/Code 20 process started 6 months ago. There have been 40 Codes called. 14 calls were cancelled due to time or seizure. Of the remaining 26 patients, 28% had ischemic strokes, 19% TIAs, 15% seizures, 34% other and 4% ICH. One patient was treated with IV tPA and returned to home functioning at a normal baseline. Average transport to CT time is 25 minutes. This equals the national benchmark for Door to CT time for ER stroke patients. Code 20 gives the RRT nurse an effective tool to use for suspected in-hospital stroke. It allows quicker brain imaging, lab results and treatment decisions leading to improved quality patient care and patient outcomes.en_GB
dc.date.available2011-10-26T19:26:07Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:26:07Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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