Code Stroke Response Nurse

Hi

On my unit we have a Code Stroke Coordinator RN who assumes the role of code stroke RN and other various duties such as gathering info re: our stroke patients, whether guidelines were met etc. On the days and weekends that she is not on the unit, one of the staff floor RNs has to take the code stroke beeper. They usually have a full load of patients as well as the beeper. We respond to all ER code strokes. If there is a code stroke on the floor, our rapid response ICU RN will respond to the code first then call us if it looks like it could be a possible stroke. If the floor RN has to leave her patients for a code stroke, a beeper RN will come and take over her patients until she returns. Now, if there is no beeper RN (which is usually the case) then the other nurses and charge RN will absorb her patients until she returns. This is not working out well for us lately as we have switched to a primary care nursing model which means that if the RN leaves the floor then really there is no support staff to assist with cares etc.

When you call a "Stroke Code" at my facility it sends a page to the covering Neurologist and the CRN (Clinical Resource Nurse,) no RN is sent out.

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.

HI

Iwould like to know if you are still using the GSC to assess your patients i work on a storke unit and am trying to find some validation on any form of assess LOC as GCS is not stroke specific

thankyou

Betty

Where I worked we would use GCS to assess our patients as often as neuro checks were ordered. Our neuro vascular flow sheet used in each assessment ad reassessment has GCS, facial symmetry, tongue deviation (if present), speech (slurred or not), strength of motor responses (rated 0-5; 0 being flaccid/no response and 5 being full strength/no noted deficits), pupil reaction (size in mm and type of response - brisk, sluggish etc), numbness/tingling/neuropathy in extremities and a place to document pulses and other vascular data.

I usually only say NIHSS used on admission and at 24 hours past admission on strokes. It's something that was more commonly used with the stroke patients receiving tPA. I was certified to do NIHSS but it wasn't ordered on all of our questionable strokes v TIAs. We still always for any patient even suspected TIAs had to do a swallow screen. Our stoke alert meant that the hospitalist group and on call neurology would be notified. And the transfer center would look at our patient load to see if our unit could take the stroke patient (unless tPA was the plan and then the patient would be admitted to ICU and the intensivist service).

Hi Desiree

thankyou for your response i am interested in the in th ad reassessment with the facial symmetry, tongue deviation (if present), speech (slurred or not), strength of motor responses (rated 0-5; 0 being flaccid/no response and 5 being full strength/no noted deficits), pupil reaction (size in mm and type of response - brisk, sluggish etc), numbness/tingling/neuropathy in extremities and a place to document pulses and other vascular data. would i be able to get a copy of this as i am researching different tools used in the stroke area i work on a stroke unit and our patients come straight to our unit following A&E. this would be very benefical to us.

I'll PM you that info shortly :)