Tele and Stroke

[certjunkie87]

I have just started a the new stroke and cardiac care coordinator at my hospital. We are a certified primary stroke center. Before me, there was no one in the position and I came from an ER/ICU background.

I'm still trying to figure things out but one of the things our policies do not cover at all is tele and the stroke patient.

Right now all our stroke patients either go to ICU (tPA, massive hemorrhage, intubated) or our tele floor, which only has 35 beds. They stay there until they get discharged, our inhouse rehab or in house TCU.

The problem is we are having to keep patients who have been admitted with TIA or a stroke but have no deficits on the tele floor even if the doctors D/C the tele because no one on our med floor is trained in the NIHSS. We are holding patients d/t placement issues or family problems, and we need the tele beds. We are trying to get all the nurses trained but until then... does anyone work at a hospital that has a policy in place for monitoring neuro patients on tele, transferring off of the stroke floor, or transferring them out of the stroke service (ex, r/o TIA patient gets diagnosed with tumor, do you just quit following them or do all the docs have to chart they don't think it was TIA, just because of the charting requirements for all patients who code out as a stroke/TIA/CVA?)

Sorry for the long and rambling questions, but any help would be insanely appreciated!!

[nursej22, MSN, RN]

Our facility will monitor someone on tele for the first 24-48 hours to watch for Afib. And I believe the NIHSS is done q shift for 72 hours. Everyone on the med tele is NIHSS trained, but if the patient is on cardiac tele, where they are not NIHSS or the general medical floor, the med tele charge, or a resource/admit nurse, or the STAT RN will go do the stroke scale.

[hson15]

Same here. We do not have neuro/stroke unit. The 2nd floor nurses (ICU, PCU, Onc-tele) are NIHSS and tele trained, so all stroke patients are admitted on the 2nd floor. Our med/surge nurses (3rd floor) are not trained for NIHSS nor tele, so stroke patients stay in our unit even though the tele order is discontinued. It is waste of the tele bed, but should keep it this way unless the hospital decides to train 3rd floor nurses for NIHSS.

[ixchel]

The MD can order discontinuation of NIHSS, particularly when stroke has been ruled out, or when discharge is already in.

Eta - at the very least, CNs should have NIHSS.

[Anna Flaxis, BSN, RN]

I think you need to get *all* the nurses trained in NIHSS, but start with the Charge Nurses. This way, you can transfer the pt to the gen med floor, freeing up the tele bed, and at least the CN can do the NIHSS until it is DCd.