New Practice – Code Stroke & The Stroke Coordinator

by Angela Whisenant, BSN, RNWhisnant_A
Stroke Program Coordinator

What is a Stroke Coordinator?

The Stroke Coordinator spearheads efforts to establish and operate a Primary Stroke Center (PCS).  The individual works to overcome barriers and gains support from each area involved in treating stroke patients.  The Coordinator leads the Stroke Team to achieve all requirements and focuses on adherence to standards of care.  The Stroke Coordinator works as a liaison to Hospital Administration to seek guidance and financial support.  The Coordinator is responsible for the overall education plan, continuous quality improvement, monitoring performance measures, scheduling in-services, organizing team meetings, and securing necessary equipment and services as requested by stroke team members.  The Coordinator responds to all Code Strokes during regular business hours to ensure adherence to best practice standards. In the absence of the coordinator, a designated representative serves in that capacity.

A review of the calendar year 2012 – Program Inception and Evolution:

April 2012

Catawba Valley Medical Center implemented the Telestroke Network Program through Wake Forest Baptist Medical Center.

This program facilitates:
– 24/7 access to real-time virtual Neurology Consultation at the bedside.
– Improved quality and access to stroke expertise & advance therapies for patients in rural, outlying  communities like Catawba Valley.
– Better transfer processes for those requiring advanced medical services.

May 2012

Catawba Valley Health First Center integrated Stroke information into their Pink Sunday Women Health packets to educate a larger population in the community.  Our focus was recognition with earlier response to seek treatment.  This initiative was driven by Catawba County Statistics that puts Stroke as the 4th leading cause of death, with an average being higher in our county than our surrounding area (http://www.catawbacountync.gov/phealth).

August 2012

Catawba Valley Medical Center implemented the Code Stroke Team. This included Rapid Triage Practice Guidelines and Stroke Team Notification: Acute triage protocols facilitate the timely recognition of stroke and reduce time to treatment. Acute stroke teams enhance stroke care and are activated as soon as the stroke patient is identified in the emergency department or after notification from pre-hospital (EMS).  Our policy is to activate the Code Stroke Team for patients presenting to Emergency Department within 6 hours of onset of stroke like symptoms.  CVMC has the capability to give rt-PA up to 4.5 hours from onset of stroke like symptoms.  The Telestroke Program helps with coordination of transferring patients to Wake Forest Baptist Medical Center if they are beyond the 4.5 hours for Intra-arterial.  WFBMC offers Intra-arterial tPA performed by their Neurosurgical Experts for up to 6 hours.

Between 15 – 20 Code Strokes occur at CVMC monthly.  We give an average of 1-2 doses of rt-PA per month. In 2011, a total of 16 doses of rt-PA were given. In 2012, that number increased to 19 doses representing a 16% absolute increase.

Minimizing delays is a crucial step in improving outcomes with acute stroke therapies whose efficacy is clearly time dependent.

ED Code Stroke Evidenced Based Goals

1. Door to MD Evaluation time = 10 min. or less
2. Door to CT Scan initiated time = 25 min. or less
3. Door to CT & Lab interpretation times = 45 min. or less
4. rtPA initiated if candidate= 60 min. or less
Golden Hour= Door to needle less than 60 min

Did the Implementation make a difference? Results show Success!

  • Door-MD Evaluation Times reduced from 83 to 12 minutes
  • Door-CT Scan Initiation Times reduced from 18 to 11 minutes
  • Door-CT Interpretation Times reduced from 33 to 32 minutes
  • Door-Lab Interpretation Times reduced from 49 to 43 minutes
  • Door-Needle Times (Are still greater than 60 minutes…Work in progress). With a focus point on initiation on Telestroke Team earlier in the Code Stroke Process!

Performance Improvement Plan 2013

  1. Pre-Loaded Supplies Code Stroke Boxes
  2. Pre-Notification to Pharmacy
  3. Mock Code Strokes Monthly
  4. Build Relationships with EMS
    Focus education for RN/MD’s