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

2. 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.

3. 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

4. Stroke Symptom Presentations

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

6. 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!

7. 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.

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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

16. 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

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