02.04.07
The PSC maintains a Response Log for documenting each patient presenting with symptoms of acute stroke. The PSC has a process for consistently recording the following vital information into the Response Log:
1. Time of symptom onset
Staff has received training relative to the Response Log documentation
requirements.
The Response Log data are submitted to the quality improvement
subcommittee of the Acute Stroke Team for analysis and trending. These data will be used to determine opportunities for improvement for reducing in-hospital delays and improving patient outcomes.
DOCUMENT REVIEW
Review the PSC policies / protocols. Verify:
1. A Response Log is in place. 2. The Response Log contains all
required elements.
3. Staff has received training relative to Response Log documentation
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2. Time of the initial call from EMS (or other sources) of imminent arrival of a patient with acute stroke
symptoms
3. Time of the first Acute Stroke Team member arrival at the bedside (for in-patient strokes)
4. Time of activating the Acute Stroke Team alert (or time of triage if patient presents to the Emergency Department (ED)
5. Patient name or identifier 6. Diagnosis
7. Treatments 8. Outcomes
The ED time frames may be used as long as the required elements are captured.
Definition: “Time of Symptom Onset”
Time patient was last known to be without symptoms. If patient awoke with symptoms, symptom onset time is defined as when the patient went to sleep or was last known to be awake without symptoms.
NOTE: This standard is in reference to those patients who present to the facility with symptoms of acute stroke and those patients for whom the ‘Stroke Team’ is called to assess and intervene.
requirements.
SUPPORT
Human Resources STAFFING
03.00.01
Hospital and service specific policies and procedures identify basic / core staffing for acute stroke patient care needs and reflect mechanisms for altering these levels for changes in the volume, complexity or intensity of services.
The organization and staffing of the stroke program are appropriate to the scope of services offered.
The provision of high quality and efficient care is highly dependent upon the degree of commitment of the facility necessary to build the infrastructure. When considering a Primary Stroke Center, facilities should assess current capabilities for providing acute stroke care services. Additionally, it is
recommended that facilities perform an assessment of the community to determine the capabilities available in other local and regional facilities. A supportive infrastructure is demonstrated through:
The organizational chart of the
facility in which the reporting mechanisms for the Primary Stroke Center are indicated
The scope of services provided by
the Primary Stroke Center program
DOCUMENT REVIEW
Verify the following are in place:
Primary Stroke Center is included
with the facility’s organizational chart.
The Primary Stroke Center’s scope
of services is included with the facility’s Provision of Care document.
The organization has staffing
patterns in place, which define the numbers of qualified staff required to provide patient care.
Review assignment mechanisms
and interview sufficient numbers of managers and staff to determine that patient care is not jeopardized.
INTERVIEW
During the interview, facility leaders
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is described in the Provision of Care document of the facility
An adequate number of qualified
staff must be available to provide rapid diagnosis and treatment of acute stroke patients
Refer to staffing plan requirements in the following standards:
Emergency Department
Stroke Unitprovide rationale for establishing a Primary Stroke Center including community needs and available stroke care services.
Interview managers and selected staff to determine if policies are implemented and that there is sufficient numbers of qualified staff to provide the care, treatment and services required.
ORIENTATION & EDUCATION
03.00.02
Training programs are held minimally twice per year and competency on a recognized neurological assessment tool are performed annually.
NURSING
RNs working in the emergency department, cardiac catheterization laboratory and the stroke unit receive training in order to remain current with advancements in the treatment of acute stroke.
Nurses who work in departments that
care for stroke patients e.g. stroke unit, ICU attend minimum of six (6) hours of continued education specifically relating to neurovascular disease
Emergency department nurses
attend a minimum of two (2) hours of education specifically related to neurovascular disease nursing assessment and management
Stroke Code team members eight (8)
hours of Continued education specifically relating to stroke
The professional staff, including physicians, fellows, and registered nurses receive training in order to remain current with advancements in the treatment of acute stroke. The initial stabilization of acute stroke patients includes continuous cardiac and pulse oximeter monitoring, repeated vital signs, and IV access. Care of the acute stroke patient includes prevention of secondary complications such as aspiration, airway obstruction, seizures, hypertension, deep vein thrombosis, and cardiac arrhythmias. The occurrence of fever is associated with poor patient outcomes. Training shall be scheduled at least twice a year, approximately six months apart. All required topics are to be taught at least once a year. Nursing personnel are trained in the assessment and treatment of patients with all types of acute stroke.
The Emergency Department is often the first point of contact for the patient presenting with acute stroke symptoms. Emergency Department personnel are trained in the diagnosis and treatment of
DOCUMENT REVIEW
Review training records and training program.
Verify:
The PSC has provided at least two
training programs each year for nursing staff who work with acute stroke patients (and rapid response team if applicable)
Training has been provided for the
required topics
FILE REVIEW
Review personnel records of the healthcare professionals; include staff that works all shifts and weekends to ensure staff on all shifts has received the required training.
Verify:
Nursing professionals on all shifts in
acute stroke patient care areas have received the required training
Nursing professionals on all shifts in
the emergency department have received the required training
Rapid response team personnel on
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assessment and management Training programs are held minimally twice per year. Annual training includes, but are not limited to:
The Primary Stroke Center’s “Rapid
Response Protocol for Patients with Acute Stroke”
Activation of the Acute Stroke Team
Evaluation of patients presenting
with symptoms of acute stroke.
Prevention of Secondary Acute
Stroke Complications
Treatment Algorithms/Protocols
including the following:
Thrombolytic Therapy Protocols
Management of Increased
Intracranial Pressure
Management of Hypertension
Contraindications to tPA
therapy
Complications of tPA therapy
Note: If the Primary Stroke Center does not place a minimum of 30 patients on the Acute Stroke Protocol per year, the requirement for additional education to maintain competency will be an additional two training programs. If the facility does not have a designated ‘stroke unit’, this standard would be applicable to those staff members who provide care for your stroke patient population.
patients with all types of acute stroke. Rapid response teams may also be included in this training.
Annual training includes, but are not limited to:
Competency assessment on
neurological assessment tool
Rapid response protocol for patients
with acute stroke
Activation of the acute stroke team
Reliable identification of stroke
patients including symptoms and use of a standardized assessment tool
Prevention of secondary acute stroke
complications
Rehabilitation
Treatment algorithms/protocols
including the following:
a) Thrombolytic therapy protocols including contraindications and complications b) Management of increased intracranial pressure c) Management of hypertension d) Contraindications and complications of tPA
Training should also address conditions that mimic acute stroke symptoms, such as patients presenting with:
Hypoglycemia
Alcohol and drug intoxication
Postictal hemiparesis
Other non-stroke causes of acute
all shifts have received the required training
NOTE: Stroke education credit is NOT given for ACLS training.
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neurological deficits
Continuing education credits each year in cerebrovascular disease (may include conference attendance / other
recognized continuing education activities)