Abstract TP472: A Model of the Code Stroke Process for Rural Community Hospitals that Utilizes a Critical Care Nurse to Decrease Door-to-Needle Times and Improve Patient Outcomes

Abstract

Background and Purpose: In this 600 bed, non-academic community hospital, door-to-needle times soared to as high as 120 minutes in some cases. Issues ranged from high acuity patients in the Emergency Department to RN’s not knowing how to mix and give tPA. The stroke neurologist and ED physicians desired to come up with a protocol that would better serve this population of patients. Methods: A Stroke Team was established, led by the Stroke Neurologist. The team designed a Code Stroke Protocol and determined that the protocol should be led by a critical care nurse from the SICU. They would be intensely trained on the stroke protocol and would respond to all code strokes. In addition, a “code stroke backpack” was created that carries everything the nurse could need to administer tPA. The backpack includes the tPA and a nicardipine drip, among other medications that could be used during the code stroke. Having a strict protocol, a trained critical care nurse, and the medicine in a backpack, would streamline the process. Results: After initiating the new code stroke process, there was a significant decrease in door-to-needle times [78.9 min average (January 2016-February 2017)] to [36.8 min average (March 2017-December 2017)]. There was an immediate 36 minute drop the month of initiation. NIH scores have shown dramatic decreases in post tPA patients. Conclusions: In conclusion, the use of a critical care nurse to run the code stroke, proved to be highly successful and more importantly, sustainable. With a core of nurses that are proficient at the code stroke protocol, pressure was taken off of the emergency department nurses and limited issues that would prolong the administration of tPA. This process is differentiated from others by the stroke-trained nurse carrying the backpack with the medications. It should be considered in rural community hospitals with less resources than larger medical centers.