Stroke Center Newsletter

Pharmacy

Pharmacy is a member

of our acute stroke alert

team, and included as a

necessary responder for our

stroke alerts. Pharmacy

responds to every stroke

alert with the “stroke kit.

Included in the stroke kit is

everything one would need

to mix and administer TPA

(a clot busting medication).

When a patient meets TPA

criteria, pharmacy mixes TPA in

the ED, reducing transportation

times from pharmacy to ED. We

established guidelines for stroke

alert response with pharmacy, and

wrote this process into our protocol

to highlight priority response with

pharmacy arrival. We provide

feedback on all stroke alerts,

debriefing real time as well as post-intervention

feedback on benchmark times. We collected

retrospective and current data points: TPA ordered to

TPA given time, as well as door to needle times to

measure performance.

We have seen across the board improvement in the

average TPA order time to TPA administration with

100% decrease. More than half of our TPA cases have

zero minute decision to needle times. We’ve also seen a

decrease in our average door to needle times, with

appropriate cases. We attribute this to stroke team work

and pharmacy mixing TPA in the ED. The ED, stroke

team, and pharmacy partnership demonstrates high

quality stroke care we provide at our organization.

June 2015, Issue 3

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 Initial, 2 hrs Post TPA, 24 hrs Post TPA, Discharge Neurology, trained ED physicians/ICU

APRN’s use a stroke specific scoring tool called

the National Institute of Health Stroke Scale

UConn Health’s

Emergency Stroke

Care Conference The partnership between UConn

Health’s Stroke Center and EMS was

apparent after the first Emergency

Stroke Care Conference. Over 75

attended between our North Central

Regional EMS members, Regional

ENA, UConn ED staff, and Hospital

Staff attended this course. Due to the

positive feedback and high attendance

by EMS we will be

providing this conference

annually every May.

EMS : Bloomfield Thank you to Bloomfield

EMS for inviting the

stroke center team out to

present at your CME

event!

Stroke Center News: Congratulations to JDH on achieving the American

Heart Association, Bronze Stroke Award!

Stay Tuned for Future Issues of our Stroke Team

Newsletter as we continue to focus on ways to im-

prove Door-to-Needle times and patient outcomes.

Case Study: Door to Needle 60 minutes May 4, 2015– American Medical Response paramedic Terry Webb and her partner Andrew Badamo responded in

West Hartford for an 88 year old female with an onset of

right-sided weakness while dining at her senior living facil-ity. Webb documented the last known well time and called

in a Stroke Alert to John Dempsey Hospital. On arrival, the patient went directly to CT

Scan on the EMS stretcher. The scan was

negative for acute hemorrhage or sign of acute ischemia. The patient who had garbled

speech, facial droop, and right-sided weakness

was given a rapid stroke work up by the ED team: Dr. Sara Blomstrom, William Garrity RN, Leslie Mulhall RN, Mari-

tza Perez, MA, Jaccqueline Tittarelli, and Kim Zalaski RN.

The patient received TPA and was then admitted to the ICU

for monitoring. The patient showed great improvement and

was discharged 4 days later with her symptoms essentially resolved. The patient was put on new medication for blood

pressure control, and will follow-up with Neurology. Thanks to EMS calling in a Stroke Alert, Radiology for

rapid CT imaging, pharmacy rapid mixing of TPA, the ED,

ICU, and CSDU team. The patient received TPA within its therapeutic window with positive results. Great job!

Patient Feedback: Stroke Coordinator follows

up after discharge via phone and also satisfaction

survey to obtain patient feedback– all positive and

negative feedback given to appropriate care team.

Stroke Data Quarter 2: Increase Stroke Alert’s

Stroke Alert Responders

Arrival average= 7 min

100% EMS stroke alerts

go directly to CT on EMS stretcher (Thank you to the excellent collaboration between EMS,

the ED staff, CT scan/Radiology)

Door to CT scan (< 25 min) = Avg. 14 min

Door to CT results (< 45 min) = Avg. 23 min.

100% Stroke Joint Commission Core Measures

>85% American Heart Performance Measures

100% Door to Needle (TPA) within 60 min

*Dysphagia Screening *NIHSS documented:

prior to PO intake:

STROKE UNITS

ED, ICU,

CSDU, Med 4

Community Outreach: Stroke Survivor Group:

4th Wednesday of the month, in the OP

Pavilion. Light snacks offered. Open to

all for attendance. Please let your patient’s

know about this positive resource.

Stroke Center is a Dream Team

Member! Providing Stroke Education and building working relation-

ships local nursing homes to collaborate and standard stroke

education throughout the care continuum

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

Dysphagia Screen Update 1:1 Education

*ED/ICU received 1:1 Education on VS/Neuro Checks

frequency in regards to Post TPA Management

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

SABA, FAST/Stroke will be included in hospital mandatories

*Stroke Mock Tracers Continue

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: 8/4, 8/18, 11/3, 11/24, 12/1, 12/15

(other dates without CE credit: 9/1, 9/22, 10/6, 10/20)

The Stroke Center helped Celebrate Nurses Week May 6, 2015