2.50
Hdl Handle:
http://hdl.handle.net/10755/306590
Category:
Abstract
Type:
Poster
Title:
Stroke Treatment: Putting FAST into the Treatment Plan
Author(s):
Behrens, Sue
Lead Author STTI Affiliation:
Non-member
Author Details:
Sue Behrens, DNP, RN, ACNS-BC, NEA-BC, Sue.A.Behrens@osfhealthcare.org
Abstract:

Evidence-based Practice Abstract

Purpose: Stroke treatment centers are hospitals that specialize in the coordination and treatment of stroke at every level, including diagnosis, and treatment. The purpose of this project was to establish and sustain a comprehensive hospital and regional stroke treatment plan that started in the pre-hospital setting, and ended with the patient receiving tissue plasminogen activator.

Design: This quality and patient safety project was a collaborative effort between the Stroke Center, emergency medical services, emergency department, Neuro-imaging, pharmacy, and laboratory services.

Setting: The program was developed in a 57 bed emergency department of a Level 1 Trauma Center with 86,000 visits per year.

Participants: All patients presenting with stroke symptoms, or positive face, arm, speech, and time exams.

Methods: The project development began with collaboration of emergency medical services. Education on stroke was provided to pre-hospital agencies, including a mock stroke demonstration, and focus exam on face, arm, speech, and time. Education on the stroke protocol provided timely pre-hospital assessment and notification of acute strokes to the receiving emergency department. Drip and ship model was created for 34 rural hospitals that included 94 cases receiving tissue plasmingoen before being transferred by helicopter. The emergency department created a protocol that could be initiated upon patient arrival, including Triage. Emergency department staff was given stroke badge cards with signs and symptoms of a stroke. Tissue plasminogen activator, along with tubing, syringes, flushes and National Institutes of Health scale book, was placed in Pyxis medication machines throughout the department. Dedicated emergency department pharmacists assisted with all tissue plasminogen activator administration, and neuro-imaging and laboratory services were available 24/7. Laboratory services made stroke patients a high priority with point of care testing for International Normalized Ratio available.

Results/Outcomes: The largest ambulance agency became a member of the stroke team. A total of 1022 patients received stroke treatment in 2012, with 225 patients receiving focused face, arm, speech, time exams. Average door to computed tomography is 20 minutes. Average door to computed tomography read by radiologist is 39 minutes. Average FAST page to finished computed tomography is 11 minutes. Average FAST page to computed tomography read by radiologist is 30 minutes. Fastest door to tissue plasminogen activator times include nine and five minutes, both are among the fastest in the world. The five minute time was related to the neurosurgeon already present in the emergency department. In 2012 93% of the patients were treated less than 60 minutes, and 52% were treated less than 35 minutes. Of these patients, 71% of all strokes went home or to a rehabilitation unit, 2% had a symptomatic intracranial hemorrhage, and 10% expired or went to hospice service.

Implications: Establishing a pre-hospital protocol with a stroke exam and evaluation provides best practice and timely medical care for patients who are having symptoms of a stroke.

Keywords:
Stroke Treatment Plan
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
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.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleStroke Treatment: Putting FAST into the Treatment Planen_GB
dc.contributor.authorBehrens, Sueen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsSue Behrens, DNP, RN, ACNS-BC, NEA-BC, Sue.A.Behrens@osfhealthcare.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306590-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Stroke treatment centers are hospitals that specialize in the coordination and treatment of stroke at every level, including diagnosis, and treatment. The purpose of this project was to establish and sustain a comprehensive hospital and regional stroke treatment plan that started in the pre-hospital setting, and ended with the patient receiving tissue plasminogen activator.</p><p>Design: This quality and patient safety project was a collaborative effort between the Stroke Center, emergency medical services, emergency department, Neuro-imaging, pharmacy, and laboratory services.</p><p>Setting: The program was developed in a 57 bed emergency department of a Level 1 Trauma Center with 86,000 visits per year.</p><p>Participants: All patients presenting with stroke symptoms, or positive face, arm, speech, and time exams.</p><p>Methods: The project development began with collaboration of emergency medical services. Education on stroke was provided to pre-hospital agencies, including a mock stroke demonstration, and focus exam on face, arm, speech, and time. Education on the stroke protocol provided timely pre-hospital assessment and notification of acute strokes to the receiving emergency department. Drip and ship model was created for 34 rural hospitals that included 94 cases receiving tissue plasmingoen before being transferred by helicopter. The emergency department created a protocol that could be initiated upon patient arrival, including Triage. Emergency department staff was given stroke badge cards with signs and symptoms of a stroke. Tissue plasminogen activator, along with tubing, syringes, flushes and National Institutes of Health scale book, was placed in Pyxis medication machines throughout the department. Dedicated emergency department pharmacists assisted with all tissue plasminogen activator administration, and neuro-imaging and laboratory services were available 24/7. Laboratory services made stroke patients a high priority with point of care testing for International Normalized Ratio available.</p><p>Results/Outcomes: The largest ambulance agency became a member of the stroke team. A total of 1022 patients received stroke treatment in 2012, with 225 patients receiving focused face, arm, speech, time exams. Average door to computed tomography is 20 minutes. Average door to computed tomography read by radiologist is 39 minutes. Average FAST page to finished computed tomography is 11 minutes. Average FAST page to computed tomography read by radiologist is 30 minutes. Fastest door to tissue plasminogen activator times include nine and five minutes, both are among the fastest in the world. The five minute time was related to the neurosurgeon already present in the emergency department. In 2012 93% of the patients were treated less than 60 minutes, and 52% were treated less than 35 minutes. Of these patients, 71% of all strokes went home or to a rehabilitation unit, 2% had a symptomatic intracranial hemorrhage, and 10% expired or went to hospice service.</p><p>Implications: Establishing a pre-hospital protocol with a stroke exam and evaluation provides best practice and timely medical care for patients who are having symptoms of a stroke.</p>en_GB
dc.subjectStroke Treatment Planen_GB
dc.date.available2013-12-09T17:00:19Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:19Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_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.en_GB
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