Stroke Team Newsletter - UConn Health€¦ · 2015 Stroke Core Measures 1. VTE prophylaxis by...

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Stroke Team Newsletter Primary Stroke Center Certification UConn Health’s John Dempsey Hospital has been doing an exceptional job with Stroke care since the program began this summer. In December, UConn Health’s Stroke Program welcomed a certification visit by The Joint Commission. This was an extremely positive experience. The surveyor congratulated the Stroke Program and UConn Health for its collaborative efforts between the Stroke Units, Lab, Pharmacy, Radiology, Neurology, and Rehabilitation Services. As the surveyor looked through records, policies/procedures and spoke with the interdisciplinary teams, patients, and families, the result of hard work and dedication in providing excellence in stroke care was apparent. We received our final award letter which certifies UConn Health as a Primary Stroke Center as of 12/13/2014! Primary Stroke Center Certification: Recognizes hospitals that meet established standards to optimize stroke care outcomes and provide clinical excellence. Congratulations to our stroke units, ED, ICU, CSDU, and Med 4, John Dempsey Hospital, and our prehospital and post hospital care teams. Every area prepped themselves for the certification visit, we could not have been successful without you all. The team work and collaboration demonstrated to create his program is indescribable. March 2015, Issue 2 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. 2015 Stroke Core Measures 1. VTE prophylaxis by admission day 2 2. Antithrombotic therapy at D/C 3. Afib/Aflutter patient D/C with anticoagulation 4. Arrives w/in 2 hrs. of LKW, receive TPA w/in 3 hrs. 5. Antithrombotic therapy by end of hospital day 2 6. LDL measured 7. Educational materials given at D/C 8. Assessed for rehabilitation services 2015 Performance Measures Dysphagia Screen 100% of patients NIHSS scale (provider) per protocol VS/Neuro on TPA patients per protocol Door to Needle (TPA) within 60 min D/C on Intensive Statin Therapy American Heart/American Stroke Honor Roll: Door to needle within 60 minutes 50 % or more of the time. Last year our average was 64 minutes, we can meet this goal! Performance Goals: Door to Stroke Team (≤ 15 min) Door to Doc (≤ 10 min) Team arrival: (≤ 10 min) Door to CT/MRI time (≤ 25 min) Door to CT/MRI Results (≤ 45 min) Door to Labs (≤ 45 min) Door to Lab Results (≤ 55 min) Door to needle: TPA time(≤ 60min) Door to stroke unit: (≤3 hours) POST TPA VS/NEURO CHECK 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 hours Post TPA, 24 hours Post TPA, Discharge. Neurology or trained ED physicians or APRNs use stroke specific scoring tool called a NIHSS

Transcript of Stroke Team Newsletter - UConn Health€¦ · 2015 Stroke Core Measures 1. VTE prophylaxis by...

Page 1: Stroke Team Newsletter - UConn Health€¦ · 2015 Stroke Core Measures 1. VTE prophylaxis by admission day 2 2. Antithrombotic therapy at D/C 3. Afib/Aflutter patient D/C with anticoagulation

Stroke Team

Newsletter

Primary Stroke Center

Certification

UConn Health’s John Dempsey Hospital has been

doing an exceptional job with Stroke care since

the program began this summer. In December,

UConn Health’s Stroke Program welcomed a

certification visit by The Joint Commission. This

was an extremely positive experience. The

surveyor congratulated the Stroke Program and

UConn Health for its collaborative efforts

between the Stroke Units, Lab, Pharmacy,

Radiology, Neurology, and Rehabilitation

Services. As the surveyor looked through records,

policies/procedures and spoke with the

interdisciplinary teams, patients, and families, the

result of hard work and dedication in providing

excellence in stroke care was apparent.

We received our final award letter which

certifies UConn Health as a Primary Stroke

Center as of 12/13/2014!

Primary Stroke Center Certification: Recognizes

hospitals that meet established standards to

optimize stroke care outcomes and provide

clinical excellence.

Congratulations to our stroke units, ED, ICU,

CSDU, and Med 4, John Dempsey Hospital, and

our prehospital and post hospital care teams.

Every area prepped themselves for the

certification visit, we could not have been

successful without you all. The team work and

collaboration demonstrated to create his program

is indescribable.

March 2015, Issue 2

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.

2015 Stroke Core Measures 1. VTE prophylaxis by admission day 2

2. Antithrombotic therapy at D/C

3. Afib/Aflutter patient D/C with anticoagulation

4. Arrives w/in 2 hrs. of LKW, receive TPA w/in 3 hrs.

5. Antithrombotic therapy by end of hospital day 2

6. LDL measured

7. Educational materials given at D/C

8. Assessed for rehabilitation services

2015 Performance Measures

Dysphagia Screen 100% of patients

NIHSS scale (provider) per protocol

VS/Neuro on TPA patients per protocol

Door to Needle (TPA) within 60 min

D/C on Intensive Statin Therapy

American Heart/American Stroke Honor Roll: Door to needle within 60 minutes 50 % or more of the

time. Last year our average was 64 minutes, we can meet

this goal!

Performance Goals: Door to Stroke Team (≤ 15 min) Door to Doc (≤ 10 min) Team arrival: (≤ 10 min) Door to CT/MRI time (≤ 25 min)

Door to CT/MRI Results (≤ 45 min) Door to Labs (≤ 45 min) Door to Lab Results (≤ 55 min) Door to needle: TPA time(≤ 60min) Door to stroke unit: (≤3 hours)

POST TPA VS/NEURO CHECK 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 hours Post TPA, 24 hours Post TPA, Discharge.

Neurology or trained ED physicians or APRNs use stroke

specific scoring tool called a NIHSS

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Case Study–

Door to Needle 36 minutes American Medical Response paramedics

Ron Gosselin and Ross Chagnon responded

in West Hartford for a 86 year old male with sudden onset of

right-sided facial droop, aphasia and inability to follow

commands. They called in a Stroke Alert to John Dempsey

Hospital. The patient was met by the hospital ED team,

Michelle Bordonaro RN, Kate Ireland RN, Leslie Mulhall

RN, Dr. Hunter-Anderson, Jen Sposito Stroke Coordinator,

and Neurology Residents Dr. Khan and Dr. Al-Zahmi, and

went straight to CAT SCAN on the EMS stretcher. The CT

scan showed no evidence of acute infarct or intracranial

hemorrhage. The patient met the criteria for TPA, which is

the only FDA approved treatment for ischemic stroke (it

dissolves the clot and improves blood flow and may improve

outcomes) when given within 3 hours on onset. The patient

was given TPA just 36 minutes after arriving in the ED, and

56 minutes after EMS arrival at the patient side. The patient

was admitted to the ICU and later transferred to the stroke

unit, where he received rehabilitation services. A repeat CAT

Scan showed the patient had suffered a left cortex stroke. He

has shown minor improvement during his stay was

discharged back to his SNF for further rehabilitation. While

the patient has not returned to his baseline, the speedy work

of the EMS/ED/Neurology team gave him the best possible

chance at limiting the terrible disability of stroke.

UConn Primary Stroke Center Updates

Please visit The Stroke Program’s new website:

http://www.uchc.edu/patients/services/stroke/

Update has been made to Stroke D/C checklist

NEW TPA Vs/Neuro and NIHSS checklist

Bedside Swallow electronic for inpatient units.

Located under shift assessment

Stroke Data Quarter 1: Door to Stroke alert Average is 6 minutes

100% EMS stroke alerts go directly to CT on EMS

stretcher

Stroke alert labs turn around time : 14 minutes.

100% Stroke Joint Commission Core Measures

>85% American Heart Performance Measures

Stroke Education given: Stroke Stoplight document

Stroke Recovery Book

Multidisciplinary Stroke Prevention Patient Education Form

Dysphagia Screening

prior to PO intake:

Stroke Volume: Increasing

EMS & Community Outreach EMS feedback forms:

Check out the EMS room for up

to date EMS feedback forms.

They include the EMS stroke

check list:

Discovery Series: 2/10/15-

Our stroke booth

implemented stroke screens

with F.A.S.T. and stroke

education to over 150

community members!

UPCOMING EVENTS Prehospital Stroke Care Conference-

May 16, 2015 -UConn Health will be holding an

EMS Stroke Conference on Saturday May 16 from

8:30-12pm. Topics will include Anatomy and

Physiology of Stroke, Prehospital Assessment, Stroke Alerts, In

Hospital Stroke Treatment/TPA, Vague Stroke Symptoms,

Stroke Mimics, Future of Stroke Treatment. 3 Hours CME for

EMS providers. Work-books provided. Registration Required.

Space Limited, but Free of Cost. More Details Soon. Open to all

staff. Neurocritical Care Educational Series: Date/time has

been changed to 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: 4/28, 5/5, 5/26, 6/16, 6/30, 7/7, 7/21, 8/4,

8/18, 9/1, 9/22, 10/6, 10/20, 11/3, 11/24, 12/1, 12/15

Upcoming topics: ICH, Door to Needle

Stroke survivor group: First session May 27th 12-1pm 3rd

floor OPP clinic. Reoccurring the 4th Wed of every month.