Stroke Center Newsletter

Radiology

EMS Stroke Alerts/Early

Notification go Directly

to CT SCAN Paramedics call in Stroke Alerts

from the scene (if possible)

rather than during transport.

EMS providers are educated to

use a Cincinnati Stroke Scale and alert the ED, “I

have a high suspicion of a stroke.” The Radiology

department clears the CT table and the patients go

directly to CT on the EMS Stretcher.

*Currently 100% of EMS stroke alerts go direct

to CT scan*

Thank you to the excellent collaboration

between EMS, the ED staff, CT scan/Radiology!

September 2015, Issue 4

UConn Primary Stroke Center News On October 20th, we will implement the Nursing

Neurological Assessment for Stroke Scale

(NNAS), a more focused neuro evaluation that will

help us better recognize neuro changes specific to

stroke. All RNs on our stroke units (ED, ICU,

CSDU, Med 4, and all float pool staff) have been

educated on how to score the NNAS.

Scoring tools are now available on the units in the pink stroke

folders. Documentation is electronic. NNAS & additional

assessments videos have been posted on Tips & Timesaver’s

under the nursing webpage.

CONGRATS

TO MED 4!!!

The first unit

to complete

this important

education!

POST TPA VS/NEURO √ FREQUENCY Q15 minutes x 2 hours , Q 30 minutes x 6 hours,

then Q1hour x 16 hours (for a total of 24 hours)

POST TPA NIHSS FREQUENCY Neurology, trained ED physicians/ICU APRN’s

use a stroke specific scoring tool called the Na-

tional Institute of Health Stroke Scale

Initial, 2 hrs Post TPA, 24 hrs Post TPA, Discharge

2015 Stroke Education Completed!!!! *Stroke Units: 1. Right vs. Left Sided Stroke Symptoms SABA

2. Dysphagia Screen Update 1:1 Education

3. 2015 Stroke Alert SABA

4. NNAS Stroke Class September/October

*Additionally for ED/ICU: 1:1 Education on VS/Neuro Checks frequency in regards to

post rtPA management and rtPA worksheet.

*Stroke Units+ Entire Hospital Staff: 2015 “Stroke Alert” SABA

*Stroke Mock Tracers continue in all departments*

Neurocritical Care Educational Series: Tuesdays from 12-1pm in Low Learning Center. This lecture is

videotaped on Mediasite and offers with 1 hour nursing CE for

attendance of the live session and completion of an evaluation. Upcoming dates: 10/20, 11/3, 11/24, 12/1, 12/15

Thank you everyone for completing your required education

and helping to meet our initiatives of clinical excellence for

Primary Stroke Center Certification.

Stay Tuned for Future Issues of our Stroke Team

Newsletter as we continue to focus on ways to improve

Door-to-Needle times and patient outcomes.

Policy Location: Ischemic & Hemorrhagic Stroke Hospital Administration Manual ( Clinical Care Guidelines #1)

ALSO Located by: Nursing Practice Manual: “Stroke: Ischemic &Hemorrhagic”

Linked in Ischemic/TIA order set

Under “Links” tab in inpatient POE system.

Case Study #1 in GI:

The Endoscopy GI suite had their first Stroke

Alert. Staff recognized acute F.A.S.T. Stroke

Symptoms and used 7777 to initiate a Stroke Alert.

The stroke team brought the patient immediately

for a head CT. The patient was then transferred to

our ICU Stroke Unit all within 30 minutes. Great

job GI suite with your timely recognition and quick

response to this emergent situation!

Case Study #2: EMS Stroke alert in ED September 30, 2015– American Medical Response

paramedic Keith Slater and his partner Michael Law-

rence responded in Plainville for a 28 year old male

with a sudden onset of slurred speech, facial droop and

left-sided weakness, accompanied by a short episode of

shaking. Slater called in a Possible Stroke Alert to

John Dempsey Hospital, where the patient was

brought directly to CT scan on the EMS stretcher. The

scan was negative for acute hemorrhage or ischemia.

ED Staff Dr. Matt Leford, Kathy Gilbert, and Karen

Bilodeau completed the stroke work up quickly. The

patient ,who stated a family history of CVA at an early

age, consented to receive TPA after weighing the risks

benefits with the medical staff. He was given TPA with-

in 37 minutes of arrival and within 59 minutes of first

EMS contact. He showed great improvement in his

symptoms and was admitted to the ICU for monitoring

and neuro checks from Tim Bernard and Lyndsay

Escajeda. An MRI done the next day revealed no signs

of stroke damage. An EEG also ruled out seizure. He

was discharged home and told to follow-up with

Neurology.

Stroke Data Quarter 3:

Stroke Labs Turn

Around Time Goals:

Door to Labs (≤ 45

min) = Avg 23.5 min

Door to Lab Results

(≤ 55 min) = Avg 36

*Stroke Alert Responders Arrival average= 5 min

100% Stroke Joint Commission Core Measures

>85% American Heart Performance Measures

Door to Needle (rtPA) within 60 min= Avg. 50 min

*Door to CT scan (< 25 min) = Avg. 18 min

*Door to CT results (< 45 min) = Avg. 32 min.

Stroke Survivor Group: 4th Wednesday of the month.

Upcoming dates: October 28th,

November 25th, December 23rd.

Location: Outpatient Pavilion

Light snacks offered. Open to all

survivors and their families.

Please let your patients know

about this positive resource.

EMS & Community Outreach:

EMS Partners The last 5 EMS patients who received rtPA all

had First Medical Contact times (68, 83, 80, 59, 59) of 90

minutes or less thanks to EMS stroke recognition and pre-

hospital stroke alerts with the patients going direct to CT

scan. (First Medical Contact is defined as EMS at Patient

side). The Door to TPA times for these 5 patients were 51,

50, 54, 40, and 37 minutes.

Great job by our EMS partners!

Stroke Center & Dream Team! October 15th Care Coordination

Stroke Center Booth.

The 3rd Annual Case Management

Week Fair attendees included

UConn Health/JDH hospital staff,

patients, and families from our

community. Stroke Educational

Materials, hand outs, and raffles

took place.

0

5

10

15

20

25

30

35

40

1ST QTR 2ND QTR 3RD QTR 4TH QTR

Av

era

ge

TA

T (

min

ute

s)

STROK Alert 2015

Rec'd to Ver (minutes)) Coll to Ver (minutes)