2.50
Hdl Handle:
http://hdl.handle.net/10755/162538
Type:
Presentation
Title:
Save the Penumbra -Time is Brain
Abstract:
Save the Penumbra -Time is Brain
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Nowlan, Catherine, RN, CEN
P.I. Institution Name:Mary Washington Hospital, ED
Title:Performance Improvement Coordinator
Contact Address:1001 Sam Perry Blvd., Fredericksburg, VA, 22401, USA
Contact Telephone:540-741-2123
Co-Authors:Natalie Root, RN, MSN, CEN
[Annual Conference] Clinical Topic: Stroke continues to be the fourth leading cause of death and the most frequent cause of permanent disability in the world. Evidence suggests that acute ischemic stroke care is uneven and requires the development of protocols to ensure that patients are consistently treated and discharged according to standard guidelines. Standards of care for stroke include rapid transport to the hospital or stroke center, rapid diagnosis of ischemic or hemorrhagic stroke by computerized tomography (CT) scan of the brain, and rapid treatment with tissue plasminogen activator (tPA) if indicated. In retrospective review of the care and management of acute ischemic stroke patients in our facility, there was undoubtedly a need for standardization of care. We developed reliable performance measures to implement change with our main focus of improving the compliance with tPA usage for ischemic stroke patients

Implementation: Analysis of the care given to acute ischemic stroke patients has been evaluated since May 2008. We identified performance measures and quality indicators to develop guidelines for treatment. We implemented written care protocols that were exercised by the "Code Neuro" team. This "Code Neuro" process was a collaborative effort between the emergency department, radiology, laboratory, inpatient units and neurologist to streamline treatment. Education began with our emergency department staff including; physicians, nurses, paramedics, EMTs, transporters, patient ambassadors and health unit coordinators. "Code Neuro" education focused on time intervals from the patient's arrival to tPA time; how to administer tPA; indications and contraindications for tPA; risk and benefits of tPA; and signs and symptoms of neurological deterioration. Many changes were made to streamline the treatment for these patient such as: updating the clot box with the tPA and appropriate forms, creation of a Emergency Department checklist for stroke patients, outlining each team member's job description in the room, collaboration with CT for priority one head CT, creation of an electronic tPA flow sheet for charting, implementing I-Stat international normalized ratio (INR) testing, and standardizing the neurological assessment by obtaining NIH (National Institute of Health) stroke scale certification for nurses. Revision of the acute ischemic stroke order sets and the stroke policy were completed to reflect our flow changes. Evaluation of our process has been reviewed monthly at the stroke steering committee meeting. Each patient included in the initiative has a complete chart audit with the performance measures reviewed.

Outcomes: After eight months of evaluation the compliance in tPA usage is as follows: May 29%; June 25%; July 50%; August 100%; September 100%; October 75%; November 50%; and December no cases to review.

Recommendations: It is known that rapid treatment for stroke, particularly the use of clot-busting drugs, can save lives and reduce disability. However, these drugs can only be used within 180 minutes of symptom onset - that's why it's so critical to have a multidisciplinary team in place that can respond rapidly in these cases. Emergency departments are on the frontline for these patients. The development and implementation of a "Code Neuro" team is highly recommended.
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.titleSave the Penumbra -Time is Brainen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162538-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Save the Penumbra -Time is Brain</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">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Nowlan, Catherine, RN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Mary Washington Hospital, ED</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Performance Improvement Coordinator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1001 Sam Perry Blvd., Fredericksburg, VA, 22401, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">540-741-2123</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Catherine.nowlan@medicorp.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Natalie Root, RN, MSN, CEN</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical Topic: Stroke continues to be the fourth leading cause of death and the most frequent cause of permanent disability in the world. Evidence suggests that acute ischemic stroke care is uneven and requires the development of protocols to ensure that patients are consistently treated and discharged according to standard guidelines. Standards of care for stroke include rapid transport to the hospital or stroke center, rapid diagnosis of ischemic or hemorrhagic stroke by computerized tomography (CT) scan of the brain, and rapid treatment with tissue plasminogen activator (tPA) if indicated. In retrospective review of the care and management of acute ischemic stroke patients in our facility, there was undoubtedly a need for standardization of care. We developed reliable performance measures to implement change with our main focus of improving the compliance with tPA usage for ischemic stroke patients<br/><br/>Implementation: Analysis of the care given to acute ischemic stroke patients has been evaluated since May 2008. We identified performance measures and quality indicators to develop guidelines for treatment. We implemented written care protocols that were exercised by the &quot;Code Neuro&quot; team. This &quot;Code Neuro&quot; process was a collaborative effort between the emergency department, radiology, laboratory, inpatient units and neurologist to streamline treatment. Education began with our emergency department staff including; physicians, nurses, paramedics, EMTs, transporters, patient ambassadors and health unit coordinators. &quot;Code Neuro&quot; education focused on time intervals from the patient's arrival to tPA time; how to administer tPA; indications and contraindications for tPA; risk and benefits of tPA; and signs and symptoms of neurological deterioration. Many changes were made to streamline the treatment for these patient such as: updating the clot box with the tPA and appropriate forms, creation of a Emergency Department checklist for stroke patients, outlining each team member's job description in the room, collaboration with CT for priority one head CT, creation of an electronic tPA flow sheet for charting, implementing I-Stat international normalized ratio (INR) testing, and standardizing the neurological assessment by obtaining NIH (National Institute of Health) stroke scale certification for nurses. Revision of the acute ischemic stroke order sets and the stroke policy were completed to reflect our flow changes. Evaluation of our process has been reviewed monthly at the stroke steering committee meeting. Each patient included in the initiative has a complete chart audit with the performance measures reviewed. <br/><br/>Outcomes: After eight months of evaluation the compliance in tPA usage is as follows: May 29%; June 25%; July 50%; August 100%; September 100%; October 75%; November 50%; and December no cases to review. <br/> <br/>Recommendations: It is known that rapid treatment for stroke, particularly the use of clot-busting drugs, can save lives and reduce disability. However, these drugs can only be used within 180 minutes of symptom onset - that's why it's so critical to have a multidisciplinary team in place that can respond rapidly in these cases. Emergency departments are on the frontline for these patients. The development and implementation of a &quot;Code Neuro&quot; team is highly recommended.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:29:53Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:53Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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