At the facility I work at, we have had a Stroke team for Stroke alerts for about 6 years now. When we first began our program, we had our CNS (Clinical Nurse Specialist) help to develop our program. All RN's who were trained as charge nurses, were required to become certified in conducting the NIHSS assessment. Our stroke responder during the dayshift was mostly the CNS, but if she wasn't here, the charge nurse would respond. At night, it is always the responsibility of the Charge nurse. If ther is more than one alert going on at the same time, the manager may also go. If she is not in, there is usually no backup. Charge nurses used to have a full patient load, but as our stroke program has grown, so has the responsibilities of the charge nurse. He/She, not only had a full team of patients, but was also responsible for being the resourse nurse for the floor, handle customer service issues, complete staffing assignments for the oncoming shift, and responding to Stroke alerts. Long story short, our charge nurse still responds to stroke alerts in the Emergency dept as well as inpatient units, but they now are considered "out of staffing." They no longer have their own assigned patients, but of course all 40+ patients on the floor are also their responsibility.
This is how it goes now... Each stroke alert sends out a page to the charge nurse on the unit, the entire Neuroscience leadership team, the CNS, PCC (Patient placement coordinator), CT and MRI. Once the CNS, Charge nurse, or member of the leadership team responds to the Stroke alert, we are required to determine the last time seen normal, complete NIHSS, review criteria for intervention or contraindications to interventions, accompany patient and the ED/inpatient nurse to CT scan, ensure Stroke Alert orders have been initiated, collaborate and communicate with the MD/resident in the Emergency department and then call the on-call Acute Stroke Alert neurologist. We communicate to that physician, what is going on with the patient, last time normal, NIHSS score and deficits, any contraindications to treatment with IV alteplase, current relevant lab values and vital signs, etc. If he/she feels the patient is a candidate for treatment, they may come in to see patient or speak with family via phone to explain risks/benefits of treatment and obtain informed consent. Stroke RNs also have to make sure consents are signed as well. If the patient receives treatment, they must go to ICU for 24 hrs and we will have to make sure Post IV alteplase orders are initiated. We must also conduct a bedside swallow screening on all Stroke alert patients prior to any other oral intake. If the patient is not a candidate for treatment, appropriate order set must be initiated as well. We usually have to be sure to discuss this specifically with the current provider, so appropriate Stroke Core measures are not missed. Finally, if the patient will be admitted, as long as there are no acute cardiac issues, we will facilitate admission to the inpatient Neuroscience unit.