2.50
Hdl Handle:
http://hdl.handle.net/10755/162394
Type:
Presentation
Title:
Time is Brain for ED Stroke Patients
Abstract:
Time is Brain for ED Stroke Patients
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Mitchell, Anne, RN, MSN, CEN, CCRN, CNS-BC
P.I. Institution Name:Banner Baywood Medical Center
Title:CNS ED and ICU
Contact Address:6644 E. Baywood Ave., Mesa, AZ, 85206, USA
Contact Telephone:480-321-4246
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: The administration of tPA for acute ischemic stroke is recommended by the American Stroke Association nationally, but it appears that this intervention may be underutilized (Schellinger, 2001, Wojner, 2003). Because our Emergency Department (ED) treats a large volume of stroke patients, the hospital wanted improve the number of potential tPA candidates who actually received the drug.

Design: A data review of stroke patients indicated that patients who were eligible to receive tPA were undertreated. A team with a multidisciplinary focus was formed to develop a Stroke Alert system that would mobilize resources needed to identify and treat stroke patients who would benefit from fibrinolytic therapy.

Setting: This facility, located in the southwest United States, is a 342 bed community nonprofit hospital with an annual ED visit volume of 56,000.

Participants/Subjects: The primary focus was patients having acute stroke symptoms in the field within 2 + hours of symptom onset that were potential tPA candidates if they were found to have an ischemic stroke.

Methods: A multidisplinary stroke team revised ED and admitting stroke orders. A BSN prepared registered nurse with stroke expertise was hired as the stroke coordinator. A Stroke Alert Team was developed that included the stroke coordinator or stroke unit clinical manager, a laboratory technician, a respiratory therapist, an ED physician & RN. The EMS personnel implemented the Cincinnati stroke scale (FAST) as the method to identify a stroke patient in the pre-hospital setting and notified the ED when a positive score was obtained. Education was provided for ED, ICU, and Stroke unit staff on the use of the FAST score, aspects of stroke care, & data collection through a Stroke skills lab. The Stroke Alert process was implemented October of 2007. When EMS notifies the ED of a postitive FAST score, the ED physician & RN confirm suspected stroke within 10 minutes of patient arrival and a Stroke Alert is announced by overhead paging. When a Stroke Alert is announced, radiology staff clears a CT scanner, and other stroke team members respond to ED. Labs are drawn with the IV start prior to CT and the laboratory technician immediately transports the specimens to the lab. The Stroke Coordinator accompanies the patient to CT within 25 minutes of arrival, and CT results are reported by the radiologist to the ED physician within 45 minutes. Patients who are tPA eligible patients have the drug started within 60 minutes.

Results/Outcomes: By the end of 2008, 671 stroke patients were seen in the ED and 505 Stroke Alerts were called. In 2008, 29 patients received tPA, and 38 patients in 2009, compared to 5 patients receiving tPA in 2007. Stroke alert response time averages < 2 minutes.

Implications: Developing a Stroke Alert process that improves the early identification stroke patients prior to hospital arrival increases the number of ischemic stroke patients receiving fibrinolytic therapy.


Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleTime is Brain for ED Stroke Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162394-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Time is Brain for ED Stroke Patients</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Mitchell, Anne, RN, MSN, CEN, CCRN, CNS-BC</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Banner Baywood Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">CNS ED and ICU</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6644 E. Baywood Ave., Mesa, AZ, 85206, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">480-321-4246</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">anne.mitchell@bannerhealth.com</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/><br/>Purpose: The administration of tPA for acute ischemic stroke is recommended by the American Stroke Association nationally, but it appears that this intervention may be underutilized (Schellinger, 2001, Wojner, 2003). Because our Emergency Department (ED) treats a large volume of stroke patients, the hospital wanted improve the number of potential tPA candidates who actually received the drug. <br/><br/>Design: A data review of stroke patients indicated that patients who were eligible to receive tPA were undertreated. A team with a multidisciplinary focus was formed to develop a Stroke Alert system that would mobilize resources needed to identify and treat stroke patients who would benefit from fibrinolytic therapy.<br/> <br/>Setting: This facility, located in the southwest United States, is a 342 bed community nonprofit hospital with an annual ED visit volume of 56,000.<br/><br/>Participants/Subjects: The primary focus was patients having acute stroke symptoms in the field within 2 + hours of symptom onset that were potential tPA candidates if they were found to have an ischemic stroke.<br/><br/>Methods: A multidisplinary stroke team revised ED and admitting stroke orders. A BSN prepared registered nurse with stroke expertise was hired as the stroke coordinator. A Stroke Alert Team was developed that included the stroke coordinator or stroke unit clinical manager, a laboratory technician, a respiratory therapist, an ED physician &amp; RN. The EMS personnel implemented the Cincinnati stroke scale (FAST) as the method to identify a stroke patient in the pre-hospital setting and notified the ED when a positive score was obtained. Education was provided for ED, ICU, and Stroke unit staff on the use of the FAST score, aspects of stroke care, &amp; data collection through a Stroke skills lab. The Stroke Alert process was implemented October of 2007. When EMS notifies the ED of a postitive FAST score, the ED physician &amp; RN confirm suspected stroke within 10 minutes of patient arrival and a Stroke Alert is announced by overhead paging. When a Stroke Alert is announced, radiology staff clears a CT scanner, and other stroke team members respond to ED. Labs are drawn with the IV start prior to CT and the laboratory technician immediately transports the specimens to the lab. The Stroke Coordinator accompanies the patient to CT within 25 minutes of arrival, and CT results are reported by the radiologist to the ED physician within 45 minutes. Patients who are tPA eligible patients have the drug started within 60 minutes. <br/><br/>Results/Outcomes: By the end of 2008, 671 stroke patients were seen in the ED and 505 Stroke Alerts were called. In 2008, 29 patients received tPA, and 38 patients in 2009, compared to 5 patients receiving tPA in 2007. Stroke alert response time averages &lt; 2 minutes. <br/><br/>Implications: Developing a Stroke Alert process that improves the early identification stroke patients prior to hospital arrival increases the number of ischemic stroke patients receiving fibrinolytic therapy. <br/> <br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:27Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:27Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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