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National quality stroke care right here at home

Aug
19
2020

Susan Maynard, MS, RN-BC, CCNS, CCRN-CMC, stroke coordinator, Mount Nittany Medical Center

For every minute without treatment for a stroke, 1.9 million brain cells die. For every hour without treatment, the brain loses almost the same number of cells as are lost through 3.6 years of aging. When it comes to a stroke, time is brain.

A stroke occurs when a clot or broken blood vessel cuts off vital blood flow and oxygen to the brain. Strokes cause brain damage and abilities such as speech, movement, and memory can be lost. Last year, Mount Nittany Medical Center served over 450 patients who suffered a stroke.

Mount Nittany Medical Center’s Stroke Program is dedicated to optimizing the quality of life through coordinated, evidence-based best practice for stroke risk reduction and stroke interventions. The Medical Center is an accredited Primary Stroke Center through The Joint Commission and received the American Heart Association & American Stroke Association 2020 Get with the Guidelines® Stroke Gold Plus Achievement Award with Target: Stroke SM Honor Roll Elite.

“Providing evidence-based, scientific-guided care means our community can have faith in us. We are providing great care and following national guidelines,” shares Susan Maynard, MS, RN-BC, CCNS-CMC, CCRN-K, stroke coordinator, Mount Nittany Medical Center.

The Joint Commission, an independent organization that accredits and certifies healthcare organizations across the country, says the accreditation is “a signal to your community the quality of care you provide meets the unique and specialized needs of stroke patients.”

For stroke patients transported via ambulance, the care team is completely ready for them when they arrive. Emergency medical services (EMS) conducts pre-hospital assessments that are specific to stroke and calls ahead to the emergency department (ED).

The physician in the ED then calls a stroke alert, mobilizing people and processes to care for the incoming patient. If indicated, clinical staff set up the TeleStroke cart—a partnership with Hershey Medical Center to provide remote neurological consults to aid diagnosis and treatment in a patient’s home hospital. They also look up available information in the patient’s chart to incorporate any pertinent medical history.

The team meets the patient when they arrive to conduct a brief assessment before taking them for a CT scan, which was readied with the stroke alert to help the patient receive care fast. After the scan, the patient is cared for in the ED, including potentially receiving the clot busting drug alteplase.

Because speed is so important, each of the major steps has a strict national standard time goal. The door to CT scan goal is 20 minutes, door to CT scan read 45 minutes, and door to alteplase 60 minutes.

“I’m incredibly proud of how fast we give alteplase,” shares Maynard. “Back in 2012 our average time was 120 minutes. In 2019 our average time was 55 minutes and that’s with a significant increase in the number of doses. This is a huge testament to EMS, to the ED team, and to all the departments that are involved. Every time we give alteplase faster, we’re saving years of disability.”

The stroke program brings together representatives across disciplines who play a role in stroke care, including neurology, the ED, medical and progressive care units, rehab, radiology, case management, pharmacy, and hospitalists.

A relatively new initiative is having stroke nurse champions in critical care, the ED, and the medical unit. These champions attend the monthly committee meetings, bringing valuable feedback from the front line and disseminating information back to their colleagues.

“We really value our stroke nurse champions and they bring important information to our meetings. Because they are directly caring for patients with a stroke, their perspective is crucial to continue the growth of our program. Our stroke champions are often the voice of the patient, and provide feedback on how we’re doing and ways we can improve. ” explains Maynard.

Stroke care is constantly evolving. Within the past five years there has been a push to expand the treatment options for stroke, including procedures for physically removing the clot. These procedures are only done at certain stroke centers so if patients are eligible, the focus shifts to transporting them as fast as possible to an appropriate hospital. The goal is always to provide the right treatment in the right place quickly.

Susan stresses that great stroke care is always available to our community, even in the midst of COVID-19.

“Strokes will still occur in a pandemic,” she says. “They can occur to any person at any age at any time. If someone has stroke symptoms we need them to call 911 and get to the hospital by ambulance as fast as possible, so that we can treat them and stop the damage to the brain cells. Our goal is always to get people back to the life they were living before they had a stroke. If someone has symptoms, please don’t wait.”

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