Code Stroke Code Stroke: Medical Directive (PCS-MD-25) ETA: 13 minutes

Why Code Stroke? The decision was made to go to Code Stroke due to the delay in treatment that patients receive while in hospital. Admitted patients wait 50 minutes before getting a CT scan Double the recommended time. 7 out of 10 admitted in-patients do not get thrombolytics while in hospital due to delays.

Objectives: Recognize the symptoms that would indicate that code stroke be paged overhead Understand who is responsible for responding to Code Stroke Understand the process for Code Stroke Understand the Nurses responsibility

Stroke Symptom Presentations

Acute Visual Field Loss What the patient sees What the nurse observes:

The nurse can activate the Code Stroke Medical Directive within 4 hour after last being seen normal. Start the Medical Directive right away. Time is Brain!

What if the patients symptoms are rapidly improving during the assessment? Document improvement and make sure the physician is aware. You are not required to call Code Stroke if symptoms are improving.

Initial Assessment to Code Stroke The Nurse will assess the patient and determine that the situation meets the criteria for “Code Stroke” The Nurse will place a STAT call to switchboard by dialing “55” and initiating CODE STROKE providing location and room number The Nurse or delegate will follow and complete the “Code Stroke: Medical Directive (PCS-MD-25) and enter orders into Meditech promptly under the acute stroke physician on-call. Note: The Nurse will let the MRP know about the patient’s change in condition and that Code Stroke was activated

Switchboard Responsibility Switchboard will page overhead “Your attention please - Code Stroke – Location xxxx – Room Number xxxx” Switchboard will page the Acute Stroke Physician on-call and Clinical Stroke Nurse. Switchboard will page the CT Technologist. *Another Nurse should stay by the phone when CT and the Acute Stroke Physician calls back

TBRHSC Staff Responsibility Acute Stroke Physician & Clinical Stroke Nurses Will be paged specifically and be aware that there is an acute stroke patient to be seen. The Clinical Stroke Nurses work 0800 to 1600 and therefore, may not be available

TBRHSC Staff Responsibility Expectations of Staff when “Code Stroke” is paged: Home Unit Nurses Will return back to their home unit, if on break

TBRHSC Staff Responsibility Expectations of Staff when “Code Stroke” is paged: Phlebotomist Will be aware that they are required for STAT stroke blood work to be drawn in the location and room announced Note: Blood work needs to be done prior to the CT Scan Target = 10 minutes for blood draw after “Code Stroke” paged

TBRHSC Staff Responsibility Expectations of Staff when “Code Stroke” is paged: CT Technologist Paged specifically by switchboard Will ensure the patient is “NEXT ON TABLE”. The CT Tech will call the patient unit through switchboard to provide instruction for patient transfer Target = 15 minutes for CT Head after “Code Stroke” paged The nurse will transfer the patient to the CT Scanner and remain with patient

TBRHSC Staff Responsibility Expectations of Staff when “Code Stroke” is paged: ECG Technician Will be aware that they are required for a STAT ECG to be done in the room and location announced. ECG will not delay the patient transfer to CT Scanner

TBRHSC Staff Responsibility Expectations of Staff when “Code Stroke” is paged: In-patients will be transferred to the Intensive Care Unit Out-patients will be transferred to the Emergency Department If the patient meets the criteria for IV tPA the Acute Stroke Physician on-call will contact the Intensivist on-call and admit to ICU with the pre-printed direct orders “Code Stroke: tPA given (PCS-DO-69). The nurse taking care of the patient will transfer the them to ICU or Emergency Department. tPA will be given in the ICU or Emergency

Public Areas and Non-Nursing Areas For those people in public areas or care areas without nursing staff: Call an Alert 99 if suspected stroke-like symptoms are present or Code Blue if person meets criteria

The End This concludes the presentation on Code Stroke medical directive. If you have any questions, please contact your Clinical Nurse Specialist.