01: EMS Pre-Notification Door-To-Needle Processes for Success:
|
|
- George Terry
- 5 years ago
- Views:
Transcription
1 01: EMS Pre-Notification Door-To-Needle Processes for Success: Greenville Memorial Hospital Shannon Sternberg, RN, MSN, CNRN Stroke Program Coordinator Greenville Hospital System % 69 GMH ED - Stroke Alert Pages 44% 32% (Jan-Aug) After arrival SA page prior to arrival EMS notifies GMH ED Critical Care Nurse alerts ED physician & activates Stroke Alert Group Page 66% 01: EMS Pre-Notification 01: EMS Pre-Notification EMS Providers % Greenville 24 5% Laurens 22 5% MedTrans 22 5% Pelzer 50 11% Pickens GWTG-Stroke EMS from home/scene 2012 Jan-July 53% (285) Private transport 14% (77) Transfer from other hospital 33% (176) Monthly ETC & EMS Topic for 10 of 12 meetings Led by ED physician Martin Lutz, MD FACEP, Referral Development Officer EMS educational events Rachel Joseph Edwards, Director, Clinical Integration Transportation Greenville County EMS part of GHS Stroke Advisory Team ED physician & nurses responding to EMS prenotification by activating stroke alert 1
2 02: Stroke Tools 02: Stroke Tools Stroke Evaluation Orders Life or Death Status for CT & labs Nursing orders Standard BP management Online & printed packets Stroke Alert Process Prints with Stroke Eval Orders References SA criteria, time goals, dept/staff roles, IV t-pa contraindications NIHSS & Thrombolytic Communication Form Stroke Alert Progress Note New for neurologists ED Documentation IBEX Based on paper forms HPI CVA Includes prompts Includes NIHSS 03: Rapid Triage Protocol & Stroke Team Notification Stroke Acute Evaluation Orders & Stroke Alert Process define process Stroke Team Log is guiding document in organizing data for tracking & performance improvement... description of each item on the Stroke Alert Summary which will act as the stroke team log in addition to any additional medical record audits that may be deemed appropriate. The time data will be taken in the order of priority as numbered. Effort will be made to use automated times as priority when available from GHS computer systems. When automated times are unavailable, alternate recorded times will be used when appropriate... EMS calls with possible stroke patient Acute Stroke Decision Pathway Greenville Memorial Emergency Department Signs and Symptoms of Acute Stroke? Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Yes Onset less than 4.5 hr Triage in room Print Form M10357, M10108, M10682 Stroke Alert page to notify neurologist, CT & Lab MD assesses patient, NIHSS (full initially) TPA criteria reviewed (M10357) Stroke orders started (M10357) LOD labs (CBC, PT/PTT, INR, BMP) LOD Head CT STAT EKG, continuous cardiac & O2 monitoring, CXR, fingerstick glucose, urine pregnancy, NPO including meds Register patient in REACH cart (per neurologist request) Consult neurologist via REACH telemedicine TPA candidate? YES tpa Neurologist to initiated odiscuss risks/benefits w/ pt/family Goal: <60 omake recommendations for tpa in person or min via REACH & give order to ED RN RN to oadminister tpa, complete tpa orders M10682, transfer to GHS via Mobile Care or Med Trans ocomplete Dysphagia Screening ED Physician Goal: <10 min Stroke Alert Page Goal: <15 min Labs drawn & testing started - Goal: <15 min CT complete - Goal: <25 min CT & labs resulted Goal:< 45 min NOT TPA candidate ED MD to document reason in IBEX Doctor Notes, NIHSS Neurologist recommendations in person or per REACH consult ED MD calls PCP or neurologist for admission or transfer. (Follow normal admit procedure) Complete Dysphagia Screening No Onset greater than 4.5 hr Triage Patient presents to triage Stroke orders started Labs (CBC, PT/PTT, INR, BMP, fingerstick glucose, Head CT, EKG and continuous monitoring, NPO Assess using NIHSS (full initially, focused q 1 hr x 2 and then q2hr) Complete Dysphagia Screen ED MD calls PCP or Hospitalist for admission or transfer (Follow normal admit procedure) Nurse completes Dysphagia Screen before any PO Intake/Meds Stroke Alert Process GMH 2
3 EMS calls ED Report meets Stroke Alert criteria Team is paged Text message with pt name or ETA, location, call back number ED Doctor & Nurses start evaluation NIHSS Blood draw Onset, brief history Weight 03: Rapid Triage Protocol & Stroke Team Notification Neurologist responds Phone initially and/or bedside for IV t-pa Stroke Alert Page <15 bedside tpa start <45 <60 Rec d Labs CT Median ED MD Lab Result CT Head Report Admit time <10 <15 <45 <25 <45 <180 GMH :05 0:03 0:20 0:46 0:15 0:29 1:08 GMH :00 0:00 0:15 0:36 0:12 0:26 0:28 1:02 3:02 GMH :00 0:07 0:14 0:35 0:13 0:25 0:24 1:00 2:53 GMH Q1 Y12 0:00 0:08 0:16 0:35 0:15 0:24 0:22 1:00 3:12 All stroke alerts (no exclusions) Percent less than goal time Average time to goal Median time to goal 3
4 04: Single Call Activation System GHS Call Center Stroke Account 04: Single Call Activation System Type Of Code: Stroke Alert Facility: GMH 3 Type Of Call: ER GMH 1 Caller's Name: SARA Caller's Number: Patient's Name: UNKNOWN Location Of Patient: ETA 15 MIN Message History Account: Taken: Fri 21-Sep :27a 1SG Given: Fri 21-Sep :26a pgr Stroke Alert Call Center Group Page Text message Neurologists ED responders CT tech Lab Pharmacy Bed Office 05: Transfer Directly to CT Scanner Current process does not include transfer directly to CT Arrival to Critical Care ED next to ambulance bay CT across hall Initial NIHSS assessment (will be used in future implementation of CTA/CTP imaging) Lab draws required prior to CT Weight often taken to/from CT on stroke stretcher 05: Transfer Directly to CT Scanner Stroke Team Log CT Head Completed (goal < 25 min) Time on CT head film Time of CT tech documentation of CT head complete Time of radiologist documentation of CT head complete Time of ED documentation of CT head complete CT complete Average Time Median Time % < Goal GMH :20 0:15 75% GMH :16 0:12 85% GMH :17 0:13 85% GMH Q1 Y12 0:20 0:15 78% 4
5 06: Rapid Acquisition and Interpretation of Brain Imaging CT techs perform head imaging and notify radiologist to review Pager notification of Stroke Alert LOD priority puts SA pt in front of all others Room held for SA pt Hand carry requisition to radiologist for rapid read Radiologist calls preliminary report to ED physician/np Neurologist also reviews 06: Rapid Acquisition and Interpretation of Brain Imaging Stroke Team Log CT Head Reported (goal <45 min) Time of report as dictated by radiologist Time of comments related to reporting in PACS Time of radiologist dictation (when retrievable by radiology department) Time of ED documentation of report Time of neurologist documentation of CT interpretation CT Reported Average Time Median Time % < Goal GMH :35 0:29 78% GMH :31 0:26 89% GMH :29 0:25 86% GMH Q1 Y12 0:28 0:24 86% 06: Rapid Acquisition and Interpretation of Brain Imaging 46.4% 13/28 > 45 min 06: Rapid Acquisition and Interpretation of Brain Imaging Dec 08- Feb 09 Arrival to CT complete (goal < 25 min) Stroke Alert 87% ** No Stroke Alert 25% Arrival to CT reported (goal <45 min) Stroke Alert 70% No Stroke Alert 20% Arrival to Labs complete (goal <45 min) Stroke Alert 33% No Stroke Alert 9% 5
6 07: Rapid Laboratory Testing (Including POC Testing) 3 pager notification Track time to delivery & time to resulted 07: Rapid Laboratory Testing (Including POC Testing) No POC platform that will test PT/PTT using one cartridge/test/sample FDA approvals for current POC testing for monitoring current medications, not for emergent i.e. stroke situations. Would require additional training and competency for ETC staff (>200) funding to also interface these instruments. funding for new equipment Success in Coumadin Clinics due to strong leadership and a VERY limited number of staff who perform testing. Coagulation is sensitive in that one change to the test system can cause huge deviations in results. Staff turnover rates can present QC challenge Device approved for monitoring of patients on Warfarin & using as a screen is similar but would open system up to classification as a highly complex test 07: Rapid Laboratory Testing (Including POC Testing) Stroke Team Log Blood in lab (goal <15 min) Labs resulted (goal <45 min) Lab tests include a complete blood cell count with platelet count, coagulation studies, (PT, INR), and blood chemistries. Labs rec'd < 15m Labs result < 45m Average Time Median Time % < Goal Average Time Median Time % < Goal GMH :29 0:20 30% 0:55 0:46 48% GMH :20 0:15 50% 0:42 0:36 70% GMH :18 0:14 59% 0:41 0:35 73% GMH Q1 Y12 0:19 0:16 49% 0:43 0:35 67% CBC average = 24 min BMP average = 39 min PT/PTT average = 36 min ED tech included on SA page No holding of decision on labs unless exposed to anticoagulants Explore EMS drawn labs 08: Mix tpa Ahead of Time Not routinely mixed ahead of time Call made to mix when administration anticipated No contraindication identified based on history & CT Before neurologist risk/benefit discussion 6
7 09 : Rapid Access and Administration of IV t-pa 09 : Rapid Access and Administration of IV t-pa Pharmacy AIS Response SA page notification 455-PILL Prep in Main Pharmacy 24/7 Label with dosing info Bedside goal <10 min Transition in 2011 Pulling of excess dose from vial adds steps in high stress setting Pharmacy offered to mix deliver 24/7 <10 min 1. Receive stroke alert page Alert of a stroke evaluation 2. Pharmacy notified (5-PILL) Special ringtone Direct Pharmacist line 24/7 IV tech places alteplase under hood Waits for pharmacist signal to admix Always stocked in IV clean room Alaris Infusion Pump 1.Bolus & infusion program combined Call to Delivery min min 10: Team-Based Approach Stroke Alert Summary Stroke Advisory Team Neurology ED nursing & physician 2C Neuro/Stroke 4B Cardiology Medicine Neuro Trauma ICU CCU/RRT leadership Lab, CT, Pharmacy Rehab therapies (ST, OT, PT) Quality Management Greer & Hillcrest Hospitals Other depts prn EMS, neurosurgery, hospitalist, case management, patient referral center, patient placement office Meet every other month Review & development of procedures/processes Quality review of data Stroke Alert Summary Min from Time ED arrival Comments Sx onset/last known well 16:30 83 yo male w/ confusion, unable to follow commands, R facial droop, slurred speech EMERGENCY DEPARTMENT First record of ED arrival (i.e. TOG): 17:25 0:55 Brown & Bridwell Stroke Alert Page: Goal <15 min 17:15 PTA no name, ETA 5 min, called by Britt ED Physician: Goal <10 min 17:25 0:00 Knott, seen on arrival ED NP/PA response to Stroke Alert: 17:35 0:10 Mitchem, NIH 13 RADIOLOGY CT Head Ordered: LOD 17:29 0:04 Stroke protocol CT Head Completed: Goal <25 min 17:33 0:08 CT Head Reported: Goal <45 min 17:50 0:25 Farnsworth called report to Knott: no evidence of acute stroke CT Head Ordered to CT Reported: Goal <45 min 0:21 7
8 Stroke Alert Summary Stroke Alert Summary Min from Time ED arrival Comments LABORATORY Labs Drawn: LOD 17:25 0:00 Labs Ordered: 17:29 0:04 Received in Lab: Goal <15 min 17:38 0:13 Labs Drawn to Received: 0:13 CBC 1743, PT/PTT 1754 BMP 1753 Labs Resulted: Goal <45 min 17:54 0:29 Labs Ordered to Labs Resulted: Goal <45 min 0:25 NEUROLOGY Neuro phone contact: Neuro at bedside Goal <45 min 17:45 0:20 Jain, seen w/i 20 min of arrival per H&P: impression acute stroke likely related to new onset a-fib Stroke Alert to Neuro consult: 0:30 Min from Time ED arrival Comments THROMBOLYTICS TPA order/decision 17:55 time of written order tpa initiated: Goal <60 min 18:04 0:39 90 mg, Bridwell, NIH 14, TPA complete 18:55 ADMISSION Admission Goal <180 min 22:53 5:28 Admit NTICU w/ NIH 10 Outcome MRI 3/30 w/ acute embolic infarcts in L MCA distribution. DC home w/ NIH 0 on 4/6/12 Dysphagia screen 18:27 Yes NP: Score=2 Red= Exceeds time goals Green= Within time goals Yellow = Missing data 11: Prompt Data Feedback 11: Prompt Data Feedback Mean time Mean Door to IV rt-pa times for Stroke Review by neurologist of door to treatment times Poster with 40 pts receiving treatment < 60 min at GMH in 2011 EMS provider ED RN ED MD ED NP/PA CT tech/radiologist Pharmacist Neurologist min Greenville County Windsor Janse Rettew Scott/Cowley Chapman Hughes 8
UF HEALTH SHANDS CORE POLICY AND PROCEDURE. Stroke Alert Process
UF HEALTH SHANDS CORE POLICY AND PROCEDURE POLICY NUMBER: CATEGORY: CP02.078 Patient Care TITLE: POLICY: PURPOSE: Stroke Alert Process Patients who present with or develop the cardinal signs of stroke
More informationND STROKE Coordinators Case Studies. STEMI and Stroke Conference, Fargo, ND, August 5, 2014
ND STROKE Coordinators Case Studies STEMI and Stroke Conference, Fargo, ND, August 5, 2014 STROKE Coordinator Case Study Essentia Health, Fargo Essentia Health Stroke Alert Process Within 24 hours of Last
More informationPrimary Stroke Center Quality & Performance Measures
Primary Stroke Center Quality & Performance Measures This section of the manual contains information related to the quality performance of Primary Stroke Centers. Brain Attack Coalition Definitions Recognition
More informationPrimary Stroke Center Acute Stroke Transfer Guidelines When to Consider a Transfer:
When to Consider a Transfer: Hemorrhagic Stroke Large volume intracerebral hematoma greater than 5cm on CT Concern for expanding hematoma Rapidly declining mental status, especially requiring intubation
More informationProtocol for IV rtpa Treatment of Acute Ischemic Stroke
Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and
More informationIdentifying Key Players for Early Stroke Management
Identifying Key Players for Early Stroke Management Cabinet Peaks Medical Center Libby, Montana Presented by: Kimberlee Rebo and John Thornton OBJECTIVES Identify key players in early stroke care & management
More informationStroke in the Rural Setting: How You Can Make A Difference. Susie Fisher, RN, BSN Program Manager Providence Stroke Center Portland, OR
Stroke in the Rural Setting: How You Can Make A Difference. Susie Fisher, RN, BSN Program Manager Providence Stroke Center Portland, OR Outline State Statistics The Oregon Problem Time & Treatments Steps
More informationStroke Systems of Care Claire Corbett, MMS, NRP Manager of Neurodiagnostics and Stroke Center New Hanover Regional Medical Center. What do we know?
Stroke Systems of Care Claire Corbett, MMS, NRP Manager of Neurodiagnostics and Stroke Center New Hanover Regional Medical Center What do we know? Stroke: Time is Brain Shorter onset to treatment times
More informationTarget: STROKE. The Team-Based Approached
Target: STROKE The Team-Based Approached November 19, 2013 Tuesday 1300 1400 Thank you for joining today s webinar, the presentation will begin shortly. A special thank you to Cornerstone Therapeutics
More informationOHSU HEALTH CARE SYSTEM PRACTICE GUIDELINES
OHSU HEALTH CARE SYSTEM NEUROSCIENCES (includes ischemic stroke, TIA, intracerebral hemorrhage and non-subarachnoid hemorrhage) Last Reviewed Date: September 2013 POLICY STATEMENT: OHSU hospitals and clinics
More information911 Dispatch initiated! Stroke Assessment-!! Decreasing time to treatment at Stroke Centers
911 Dispatch initiated! Stroke Assessment-!! Decreasing time to treatment at Stroke Centers David Miramontes MD FACEP NREMT Emily Kidd MD FACEP Office of the Medical Director Stroke Embolic Strokes are
More informationKPNC Stroke EXPRESS EXpediting the PRocess of Evaluating & Stopping Stroke
KPNC Stroke EXPRESS EXpediting the PRocess of Evaluating & Stopping Stroke Jeffrey G. Klingman, MD 1 Disclosures None 75% DTN < 60 50% DTN < 45 Why should we care about DTN?: Time is brain 2 million nerve
More informationStroke Transfer Checklist
Stroke Transfer Checklist When preparing to transfer an acute stroke patient to the UF Health Shands Comprehensive Stroke Center, please make every attempt to include the following information: Results
More informationACCESS CENTER:
ACCESS CENTER: 1-877-367-8855 Emergency Specialty Services: BRAIN ATTACK Criteria: Stroke symptom onset time less than 6 hours Referring Emergency Department Patient Information Data: Time last known normal:
More informationThe Importance of Stroke Programs in an Acute Care Setting by Debbie Estes, RN, BSN Stroke Program Coordinator, Medical City of Dallas
The Importance of Stroke Programs in an Acute Care Setting by Debbie Estes, RN, BSN Stroke Program Coordinator, Medical City of Dallas Objectives Describe the road to the gold Discuss the importance of
More informationStroke Guidelines. November 19, 2011
Stroke Guidelines November 19, 2011 Clinical Practice Guidelines American Stroke Association Guidelines are comprehensive statements that provide the highest level of scientific evidence for clinical practice.
More informationo Unenhanced Head CT
Drip & Ship Protocol Acute Stroke Ready Hospital (ASRH) Duluth Area Primary Stroke Center (St. Luke s & St. Mary s Essentia) PATIENT LABEL Patient displays strokelike symptoms EMS/ED CSS > 0 Glucose >
More informationChinook Regional Hospital Stroke Alert Cases
Chinook Regional Hospital Stroke Alert Cases Background 53,260 ED Department visits last year Stroke Alert started October 19, 2015 106 minutes Median DTN at beginning of QuiCR project 73 Stroke Alert
More informationShands at the University of Florida Stroke Program
Shands at the University of Florida Stroke Program The only Comprehensive Stroke Center in north central Florida as designated by the Florida Agency for Health Care Administration. To transfer a stroke
More informationBY: Ramon Medina EMT-LP/RN
BY: Ramon Medina EMT-LP/RN Discuss types of strokes Discuss the physical and neurological assessment of stroke patients Discuss pertinent historical findings Discuss pre-hospital and emergency management
More information9/18/16. Setting: Community ED, 30k admissions per year Time: Friday night, 11pm. CC: Syncope
William A. Knight IV MD, FACEP Associate Professor Emergency Medicine & Neurosurgery University of Cincinnati September 21, 2016 (William.knight@uc.edu) ED as the Front Door Spectrum of care with Endovascular
More informationMercy University Hospital Stroke Service. Protocol for IV Thrombolysis for cerebral infarction
Mercy University Hospital Stroke Service. Protocol for IV Thrombolysis for cerebral infarction March 7 th 2008 Preamble Following on recent discussions exploring the possibility of administering thrombolysis
More informationJOURNEY TO ACUTE STROKE READY CERTIFICATION
JOURNEY TO ACUTE STROKE READY CERTIFICATION Bernie Oberrecht RN MSN NE-BC Director of Critical Care for St. Elizabeth Healthcare System Stroke Program Coordinator Currently @ St. Elizabeth Healthcare Edgewood
More informationPediatric Thrombectomy
Pediatric Thrombectomy Translating adult standard of care to pediatric patients DATE: September 16, 2016 PRESENTED BY: Ittai Bushlin MD, PhD and Adrienne McDougal, RN Objectives: Review acute management
More informationEmergency Department Management of Acute Ischemic Stroke
Emergency Department Management of Acute Ischemic Stroke R. Jason Thurman, MD Associate Professor of Emergency Medicine and Neurosurgery Associate Director, Vanderbilt Stroke Center Vanderbilt University,
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB Sub Phase (SUB)* Non Categorized Quality Measures STK Diet ED NPO Until Bedside Swallow Screen passed Nursing Orders Activate Code Stroke Vital Signs Q15MINS Int
More informationUpdated Stroke Clinical Handbook: Endovascular Treatment (EVT) and what it means for me
Updated Stroke Clinical Handbook: Endovascular Treatment (EVT) and what it means for me Dr Grant Stotts, Co-Chair, Provincial Endovascular Treatment Steering Committee March 29, 2017 Beth Linkewich, Provincial
More informationAcute Stroke Rescue and Recovery
Acute Stroke Rescue and Recovery Qaisar A. Shah, MD Director, Neurointerventional and Neurocritical care Nancy Arena Gogal,, RN Manager Cath/EPS/Neuro lab AMH Stroke Program Evolution 1997: Stroke Program
More informationDiagnosis: Allergies with reaction type:
Patient Name: Diagnosis: Allergies with reaction type: ICU Stroke-Ischemic S/P tpa Version 2 5/29/14 This order set is designed to be used with an admission set or for a patient already admitted Nursing
More informationMission: Lifeline Stroke Nebraska
Mission: Lifeline Stroke Nebraska What is Mission: Lifeline Stroke? Mission: Lifeline Stroke is the American Heart Association s national initiative to transform stroke care by focusing efforts on connecting
More informationImproving Systems-Based Practice to Enhance Delivery of Acute Stroke Care. Door-to-Needle Times: You Can Do It Faster!
Improving Systems-Based Practice to Enhance Delivery of Acute Stroke Care Door-to-Needle Times: You Can Do It Faster! Allyson Zazulia, MD Washington University School of Medicine St. Louis, MO Stroke &
More informationStroke: The First Critical Hour. Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP
Stroke: The First Critical Hour Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP Disclosures We have no actual or potential conflicts of interest in relation to this presentation. Objectives Discuss
More informationMaking every second count Challenges in acute stroke management Prehospital management of acute ischaemic stroke: how can we do better?
Making every second count Challenges in acute stroke management Prehospital management of acute ischaemic stroke: how can we do better? Patrick Goldstein, MD, Lille, France NIH-recommended emergency department
More informationALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
More information911 Dispatch initiated Stroke Assessment- How to decrease time to treatment at Stroke Centers
911 Dispatch initiated Stroke Assessment- How to decrease time to treatment at Stroke Centers David Miramontes MD FACEP NREMT Office of the Medical Director Conflicts of Interest Full Time Employee University
More informationEMS & Systems of Care The State of Jefferson experience with STEMI, Stroke & more
EMS & Systems of Care The State of Jefferson experience with STEMI, Stroke & more Paul S. Rostykus, MD, MPH Jackson County EMS Supervising Physician Ashland Community Hospital ED drrostykus@jcems.net 45
More informationRural emergency department best practice for treatment of acute ischemic stroke
Rural emergency department best practice for treatment of acute ischemic stroke Aubrey J. Hoye, DO Ministry Howard Young Medical Center, Woodruff, WI Ministry Eagle River Memorial Hospital, Eagle River,
More informationGUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE
2018 UPDATE QUICK SHEET 2018 American Heart Association GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE A Summary for Healthcare Professionals from the American Heart Association/American
More informationDoor-to-needle time. Context Review of evidence Data and audit Detailed approach process mapping Stress testing
Door-to-needle time Context Review of evidence Data and audit Detailed approach process mapping Stress testing Other delays Door to needle isn t everything Light bulb time Cup-of-tea time Unavoidable delays
More informationED Stroke Panel Page 1 of 2
ED Stroke Panel Page 1 of 2 Reference EMMC *************************Usec: Call Operator to page a Stroke Alert ********************** Laboratory Bedside Glucose Monitoring ONCE Notify provider if glucose
More informationDRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
More informationNeurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other
Neurosurgery Pre-Op [1710] Patient Name MRN General Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT Inpatient Only Procedure (Single Response) ( ) Admit to Inpatient Diagnosis:
More informationStroke Systems of Care. Sharon Webb, MD, FAANS, FACS, FAHA
Stroke Systems of Care Sharon Webb, MD, FAANS, FACS, FAHA Disclosures No Disclosures Objectives Describe Systems of Care Describe stroke levels of care Discuss SC stroke council state Initiatives What
More informationAdvanced Stroke Care in the context of the Cardiovascular Patient
EASTERN MAINE MEDICAL CENTER Advanced Stroke Care in the context of the Cardiovascular Patient Advancing Science in Cardiovascular Care Samoset Conference NOV 8, 2018 Dr. Gillian Gordon Perue Conflict
More informationCode Stroke!! Amit Kansara, MD, FAHA. Joint EMS Conference Providence Brain and Spine Institute Providence Heart and Vascular Institute
Code Stroke!! Amit Kansara, MD, FAHA Joint EMS Conference Providence Brain and Spine Institute Providence Heart and Vascular Institute February 22, 2019 Patient History: Dispatch 20:45: You are dispatched
More information2018 Early Management of Acute Ischemic Stroke Guidelines Update
2018 Early Management of Acute Ischemic Stroke Guidelines Update Brandi Bowman, PhC, Pharm.D. April 17, 2018 Pharmacist Objectives Describe the recommendations for emergency medical services and hospital
More informationThe impact of pre-alert on stroke thrombolysis door to needle time
The impact of pre-alert on stroke thrombolysis door to needle time John Reid - Stroke Neurologist Alexander Bown - GPST1 Andrew Barrett - 4 th year Medical student Aberdeen Royal Infirmary "Top-speed Bradford
More informationEMS Stroke Care in the Fox Valley
EMS Stroke Care in the Fox Valley MARK D. WESTFALL, D.O., FACEP, FACP MEDICAL DIRECTOR, GOLD CROSS AMBULANCE SERVICE EMERGENCY PHYSICIAN, THEDA CLARK MEDICAL CENTER Objectives Introduce / Review our Regional
More informationOperation Stroke. How to Reduce the Risk of Stroke Complications
Operation Stroke How to Reduce the Risk of Stroke Complications Objectives Focus on Acute Stroke as an active disease Discuss the most common stroke complications Describe how first 72 hours sets the stage
More informationStroke 101. Maine Cardiovascular Health Summit. Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013
Stroke 101 Maine Cardiovascular Health Summit Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013 Stroke Statistics Definition of stroke Risk factors Warning signs Treatment
More informationStroke Benchmark Presentations
Stroke Benchmark Presentations Lori Merner, Alexandra Marine & General Hospital Bonita Thompson, Huron Perth Healthcare Alliance Linda Dykes & Angela Small Sekeris, Bluewater Health Denise St. Louis, Windsor
More informationGet With the Guidelines Stroke PMT. Quality Measure Descriptions
Get With the Guidelines Stroke PMT Quality Measure s Last Updated July 2016 Print Measure s Dysphagia Screen Stroke Education Rehabilitation Considered Time to Intravenous Thrombolytic Therapy 60 min LDL
More informationEMS & Stroke NECC. Peter Moyer MD,MPH Medical Director Boston EMS, Fire and Police 9/13/06
EMS & Stroke NECC Peter Moyer MD,MPH Medical Director Boston EMS, Fire and Police 9/13/06 No financial interests to disclose EMS key and underappreciated role in stroke Stroke recognition by stroke victim
More information* * FORM REV. 02/2019 Page 1 of 4. TNKASE (tenecteplase) / ACUTE STEMI ORDERS SCHEDULED MEDICATIONS:
1. Is this a CMS inpatient only procedure? Yes, admit as inpatient, proceed to # 3 No, proceed to # 2 2. Do you expect that the patient s condition will require a hospital stay that will cross two midnights
More informationStroke Update. Lacunar 19% Thromboembolic 6% SAH 13% ICH 13% Unknown 32% Hemorrhagic 26% Ischemic 71% Other 3% Cardioembolic 14%
Stroke Update Michel Torbey, MD, MPH, FAHA, FNCS Medical Director, Neurovascular Stroke Center Professor Department of Neurology and Neurosurgery The Ohio State University Wexner Medical Center Objectives
More informationStroke Thrombolysis. Dr Peter Anderton (Stroke Consultant DBTH)
Stroke Thrombolysis Dr Peter Anderton (Stroke Consultant DBTH) Thrombolysis for ischaemic stroke Rationale Restoration of blood flow Salvage of ischaemic penumbra Schematic of the mismatch model for defining
More informationStroke & the Emergency Department. Dr. Barry Moynihan, March 2 nd, 2012
Stroke & the Emergency Department Dr. Barry Moynihan, March 2 nd, 2012 Outline Primer Stroke anatomy & clinical syndromes Diagnosing stroke Anterior / Posterior Thrombolysis Haemorrhage The London model
More informationOHSU Health Care System
Acute Stroke Practice Standard for the Emergency Department (includes ischemic stroke, TIAs, intracerebral hemorrhage, and non-subarachnoid hemorrhage), PS 01.11 Last Reviewed Date: 2/2/10 STATEMENT OF
More informationAcute Stroke Protocols Modified- What s New in 2013
Acute Stroke Protocols Modified- What s New in 2013 KUMAR RAJAMANI, MD, DM. Vascular Neurologist-MSN Associate Professor of Neurology WSU School of Medicine. Saturday, September 21, 2013 Crystal Mountain
More informationCT Department Work Flow Tip Exam: SWIFT PRIME PERFUSION BRAIN
CT Department Work Flow Tip Exam: SWIFT PRIME PERFUSION BRAIN QDOC Exam Codes Possible: CCEP-+ Protocol Required(see last slide) Systems: Ingenuity 128(CT4) Protocol Location: Exam: Revised: 3-24-14 Ct
More informationEVOLUTION IN SYSTEMS OF STROKE CARE RIDWAN LIN, MD, PHD STROKE & INTERVENTIONAL NEUROLOGY BROWARD HEALTH
EVOLUTION IN SYSTEMS OF STROKE CARE RIDWAN LIN, MD, PHD STROKE & INTERVENTIONAL NEUROLOGY BROWARD HEALTH STROKE SYSTEMS OF CARE: 7. Secondary prevention 1. Primary prevention Patient 3. Emergency transport
More informationCanadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1)
Canadian Best Practice Recommendations for Stroke Care: All patients presenting to an emergency department with suspected stroke or transient ischemic attack must have an immediate clinical evaluation
More informationStroke Systems of Care Update
Stroke Systems of Care Update Edward C. Jauch, MD MS FAHA FACEP Professor and Director, Division of Emergency Medicine Professor, Department of Neurosciences Associate Vice Chair, Research, Department
More informationIdentification and pre-notification using 12-Lead. Why this so important to our STEMI System
Identification and pre-notification using 12-Lead Why this so important to our STEMI System Jim Smith, MD Great Plains Health, North Platte Chair, NE State EMS Board Medical Director, Emergency Services,
More informationAcute Stroke Identification and Treatment
Acute Stroke Identification and Treatment James S. McKinney, MD, FAHA Medical Director, NHRMC Stroke Center SE NC is located in the buckle of the Stroke Belt, seeing the highest stroke incidence and mortality
More informationNEUROLOGY REVIEW WITH CASE STUDIES. Justin Astafan, EMT-P, CIC
NEUROLOGY REVIEW WITH CASE STUDIES Justin Astafan, EMT-P, CIC NYS EMT-P NYS CIC 17 years in the fire and ems profession Work both career and volunteer side Worked for commercial and notfor profit companies
More informationAcute Stroke with Alteplase Administration Order Set
Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:
More informationCoordination and Regionalization of Acute Care: What about stroke?
Coordination and Regionalization of Acute Care: What about stroke? Tim Lukovits, M.D. Medical Director Cerebrovascular Disease and Stroke Program at DHMC Barriers to more organized acute care unique to
More informationNURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS I. Purpose : A. To reduce morbidity and mortality associated
More informationDocument Title: The Management of Acute Ischemic Stroke & TIA
Project: Ghana Emergency Medicine Collaborative Document Title: The Management of Acute Ischemic Stroke & TIA Author(s): Rashmi U. Kothari, M.D. (KCMS/MSU), 2012 License: Unless otherwise noted, this material
More informationTherapy for Acute Stroke. Systems of Care for TIA
Therapy for Acute Stroke and Systems of Care for TIA Gregory W. Albers, MD Coyote Foundation Professor of Neurology and Neurological Sciences Director, Stanford Stroke Center Stanford University Medical
More informationEvolutions in Geriatric Fracture Care Preparing for the Silver Tsunami
Evolutions in Geriatric Fracture Care Preparing for the Silver Tsunami James Holstine, DO Medical Director for the Joint Replacement Center, Geriatric Fracture Center, Orthopedic Surgeon PeaceHealth Whatcom
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at ALL facilities Non Categorized SUB ED Chest Pain: STEMI Protocol(SUB)* SUB ED Chest Pain: STEMI Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as
More informationThrombolytics and Beyond
Thrombolytics and Beyond Greenville Memorial Rodney Leacock MD Introduction 795,000 strokes per year in the US 87% ischemic 13% hemorrhage, 3% SAH Fourth leading cause of death - was third Mortality rate
More informationUrgent Care/Triage & Transport of the Severe Stroke Patient in the Field. Robert Knight, BSN, RN, CEN, NRP, CCEMT/P INTEGRIS TeleStroke
Urgent Care/Triage & Transport of the Severe Stroke Patient in the Field Robert Knight, BSN, RN, CEN, NRP, CCEMT/P INTEGRIS TeleStroke Suggested Protocols Suggested protocols are just that. They are not
More informationEPIDEMIOLOGY AND TREATMENT OF CARDIOVASCULAR EMERGENCIES IN URBAN VS. REMOTE AREAS
EPIDEMIOLOGY AND TREATMENT OF CARDIOVASCULAR EMERGENCIES IN URBAN VS. REMOTE AREAS Andrea Semplicini Medicina Interna 1 Ospedale SS. Giovanni e Paolo - Venezia Azienda ULSS 12 Veneziana Dipartimento Medicina
More informationAdmit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests. CBC, Electrolytes, Urea, Creatinine, Glucose, INR, PTT, Urinalysis
of nurse 1. Admit under ward Attending Physician: Dr. Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests 2. On admission (if not already performed in Emergency Department or in Coronary
More informationBaseline Data Collection Tool
Endorsed by the Vanderbilt Department of Emergency Medicine Research Partner of the ED Benchmarking Alliance Baseline Data Collection Tool The data collected via this form is the baseline member data for
More informationObjectives. Stroke Facts 2/27/2015. EMS in Stroke Care: A Critical Partnership
EMS in Stroke Care: A Critical Partnership Spokane County EMS Objectives Identify the types and time limitations for acute ischemic stroke treatment options Identify the importance of early identification
More informationMultidisciplinary Geriatric Trauma Care Guideline
Multidisciplinary Geriatric Trauma Care Background Traumatic injury in the geriatric population is increasing in prevalence and is associated with higher mortality and complication rates comparted to younger
More informationStandard Precautions Droplet Precautions Standard Precautions Contact Precautions Droplet Precautions Standard Precautions Neutropenic Precautions
Unique Plan Description: Neurosurgery Subarachnoid Hemorrhage Admission Adult Plan Selection Display: Neurosurgery Subarachnoid Hemorrhage Admission Adult PlanType: Medical Version: 10 Begin Effective
More informationCode Stroke in real life. Disclosures. Parkland Memorial Hospital. I have no disclosures. Has 1 million patient visits annually. Level 1 Trauma Center
Code Stroke in real life Alejandro Magadán, M.D. University of Texas Southwestern Medical Center Medical Director for Stroke Parkland Memorial Hospital Disclosures I have no disclosures Parkland Memorial
More informationStroke Coordinator: ROI. Author: Debbie Roper, RN, MSN (d.r. Stroke) Vice President of Roper Resources, Inc.
Stroke Coordinator: ROI Author: Debbie Roper, RN, MSN (d.r. Stroke) Vice President of Roper Resources, Inc. debbie@roper-resources.com 214-864-8993 Disclosure Debbie Roper is a speaker for: Genentech Activase
More informationSTAND AND DELIVER: STANDARDIZATION OF TELEMEDICINE TRAINING FOR ACUTE STROKE CARE
STAND AND DELIVER: STANDARDIZATION OF TELEMEDICINE TRAINING FOR ACUTE STROKE CARE LEE S CHUNG, MD PETER M HANNON, MD JALEEN SMITH, BS JENNIFER J MAJERSIK, MD, MS DEPT OF NEUROLOGY, UNIVERSITY OF UTAH VA
More informationTop 5 Big Things in Acute Stroke Care! Raymond W. Grams II, DO Vascular Neurology Stroke Medical Director DRMC, Intermountain Healthcare
Top 5 Big Things in Acute Stroke Care! Raymond W. Grams II, DO Vascular Neurology Stroke Medical Director DRMC, Intermountain Healthcare Late Time Window Endovascular Trials 48.6% WITH intervention vs
More informationStroke Belt Consortium
Field Triage And Diversion of Acute Stroke Charles Sand, MD Stroke Belt Consortium 10/26/12 WCF EMS Acute Stroke Advisory Committee Formed 2001 5 Original members Now > 100 members interdisciplinary expertise
More informationImproved IPGM: Demonstrating the Value to both Patients and Hospitals
Improved IPGM: Demonstrating the Value to both Patients and Hospitals Osama Hamdy, MD, PhD, FACE Medical Director, Inpatient Diabetes Program Joslin Diabetes Center Harvard Medical School, Boston, MA Cost
More informationTeam Work in Treatment of Acute Ischemic Stroke
Diagnosis and Treatment in Acute Ischemic stroke July, 15 th 2016. Bach Mai Hospital Team Work in Treatment of Acute Ischemic Stroke Prof. Pham Minh Thong 1 Time is brain Ischemic stroke: big global burden
More informationADMIT DIABETIC KETOACIDOSIS (DKA) PLAN - Phase: Begin Immediately/Emergency Center
- Phase: Begin Immediately/Emergency Center Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Requested Location: MICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: 5E
More informationBetter identification of patients who may benefit from therapy
Jon Jui MD, MPH Large Vessel Occlusion Low rates of re-canalization after tpa Only 25 % of large vessel strokes re-canalization after tpa Newer invasive techniques Solitaire vs Merci Better identification
More informationAcute Stroke Management LUKE BRADBURY, MD 10/8/14 FALL WAPA CONFERENCE
Objectives Acute Stroke Management LUKE BRADBURY, MD 10/8/14 FALL WAPA CONFERENCE Recognize the clinical signs of acute stroke Differentiate between stroke and some of the more common stroke mimics Review
More informationWhen Not To Give TPA Steve Phillips Division of Neurology
When Not To Give TPA Steve Phillips Division of Neurology stephen.phillips@nshealth.ca AstraZeneca Disclosures - 1 I have given CME lectures and served on advisory boards for Boehringer Ingelheim Bristol-Myers
More information3. Screening Subject Identification Screening Overview
3. Screening 3.1 Subject Identification Each site will be responsible for identifying and recruiting participants into the study. It is known that screening methods vary across sites. It is, however, important
More informationWV Appalachian Stroke Network 2016 State Stroke Conference The Big Decision Packaging the Patient for Transfer
WV Appalachian Stroke Network 2016 State Stroke Conference The Big Decision Packaging the Patient for Transfer Dr. Jim Kyle, FACSM, FAAFP Regional Medical Director WVOEMS Executive Director, The Kyle Group
More informationCode Stroke Optimizing Stroke Care in the Field: The Alberta Experience
Code Stroke Optimizing Stroke Care in the Field: The Alberta Experience June 1st, 2018 Thomas Jeerakathil BSc, MD, MSc, FRCP(C) Professor Division of Neurology University of Alberta Northern Stroke Lead
More informationACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke
ACUTE ISCHEMIC STROKE Current Treatment Approaches for Acute Ischemic Stroke EARLY MANAGEMENT OF ACUTE ISCHEMIC STROKE Rapid identification of a stroke Immediate EMS transport to nearest stroke center
More informationEndovascular Neurointervention in Cerebral Ischemia
Endovascular Neurointervention in Cerebral Ischemia Beyond Thrombolytics Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington 72 y/o female with a recent diagnosis
More informationPatient Care Orders for CODE STROKE: alteplase Administration order set for Acute Ischemic Stroke less than 4.5 hours
Allergy Alert: NO YES (Refer to Care-Area Administrative Data Screen in MEDITECH) Orders: The prescriber must check the tick box or complete the blank to activate the order. Any changes to be initialled
More informationG02.2A Transport Office of the Medical Director TRANSPORT TO THE COMPREHENSIVE STROKE CENTER (HSC) Implementation date October 30, 2018
G02.2A Transport Office of the Medical Director Basic 2018-10-04 TRANSPORT TO THE COMPREHENSIVE STROKE CENTER (HSC) Implementation date October 30, 2018 17 years & older Primary Intermediate Advanced Critical
More informationDecrease cost of inpatient stay Decrease bed diversions Improve bed utilization (Interqual Criteria) Patient Satisfaction Reduce patient costs
Decrease cost of inpatient stay Decrease bed diversions Improve bed utilization (Interqual Criteria) Patient Satisfaction Reduce patient costs (family hotel, drive back to the VA for next day pick up)
More information