Second Guessing Myself. Did I handle this situation correctly?

[RosalindaRN]

I recently had a situation where I noticed my patient was becoming increasingly agitated, word salad was present, and left sided weakness was present. The patient had a head CT without contrast completed approximately 3 hours prior that was negative for stroke.

Despite the recent negative head CT, I was concerned that my patient may be actively having a stroke. I made my charge nurse aware of the situation. She assessed the patient and also suspected stroke. At this point we sent a STAT page out to the hospitalist. 15 minutes passed by and there was no response (per my hospital policy, 15 minutes is the time frame a hospitalist is expected to return a STAT page).

My charge nurse called the house supervisor at this point and made them aware of the situation. The house supervisor made the decision to ask a provider from the emergency department to assess my patient for possible stroke. The emergency department doctor came, assessed the patient, felt that the patient was having a stroke, and ordered a head CT with contrast. This CT came back positive for stroke.

Around the time all of this was happening, the hospitalist (who I had tried to page at the start of all of this) arrived on the floor and stated that he did not feel the patient had a significant change in condition and that it was wrong to call a stroke alert and involve the ED doctor. 

He stated that it made his night harder and that we should have just paged him a second time. Although the patient did come in with word salad and left sided weakness it was, in my opinion, worsening. The patient was also becoming agitated which was new. I feel that I was looking out for the best interest of my patient and I don’t know what I should have done differently. I’m a relatively new nurse so I just wanted an opinion from someone who has more experience than myself. 

[Jedrnurse, BSN, RN]

So it was wrong to call a stroke alert even though the patient had a stroke?

The hospitalist is dealing with ego/competence/guilt issues. You did fine. (I hope you documented to within an inch of your life...)

[Davey Do]

1 hour ago, RosalindaRN said:

 This CT came back positive for stroke. 

RoasalindaRN, you made a good assessment and intervention and this is proven with fact.

The hospitalist merely voiced an opinion, which was not necessarily based in fact.

Keep on keeping on!

Oh- and welcome to allnurses!

[JKL33]

Ignore comments from hospitalist.

However:

3 hours ago, RosalindaRN said:

Despite the recent negative head CT, I was concerned that my patient may be actively having a stroke. I made my charge nurse aware of the situation. She assessed the patient and also suspected stroke. At this point we sent a STAT page out to the hospitalist.

Is this your process for activating a stroke alert?

[Daisy4RN]

Sounds like you did it right to me! Maybe next time the MD will answer the page in a timely manner.

[Sweetheart2005, ASN]

It sounds to me you did the right thing. The doctor was just upset because he didn’t want to be bothered and due to his lack of timeliness you went to another doctor. He didn’t like that you went around him when he didn’t respond in a timely manner. Your steps were completely appropriate, even so,  when you weren’t sure, you went to your charge nurse who seems supportive of your assessment, and when you didn’t get a timely response you and your charge nurse went to the supervisor appropriately. 

[amoLucia]

RosalindaRN - you did GOOD!

[JBMmom, MSN, NP]

I'm not sure about your hospital but in my hospital calling a "stroke alert" does much more than get the doc there. It clears the CT room for a stat head CT, it alerts pharmacy that there may be a patient receive tPA, and for those of us that work nights it involves queuing up the tele-neurology system for a remote assessment. Too bad that doc clearly didn't take his role in that alert as seriously as he should have. You made a good call, not your fault he's butt-hurt. 

[Nunya, BSN]

You were concerned, your charge was concerned, the house sup was concerned and the ER doc was concerned.  And you were all correct. Four to one ..the hospitalist screwed up and was trying to cover their butt.  Imagine what their night would have been like if you didn't do what you did.  And if it's brought up again say exactly that.  Keep on doing what you're doing.

[CharleeFoxtrot, BSN, RN]

4 hours ago, Nunya said:

 ..the hospitalist screwed up and was trying to cover their butt.  

^^this. Methinks the Hospitalist protested too much because they erred in not responding to a STAT page.

[RosalindaRN]

20 hours ago, JKL33 said:

Ignore comments from hospitalist.

However:

Is this your process for activating a stroke alert?

To answer your question, yes, this is the process for activating a stroke alert at my hospital. 

[0.9%NormalSarah, BSN, RN]

Probably serendipity that he didn’t respond to his page. If he had seen the patient first, the patient may not have gotten the much needed new CT. Sounds like you’re an amazing nurse with great assessment skills.