MOCK STROKE ALERT
Check-Off Sheet
UNIT: XX SHIFT: NOC DATE: 4-15-09
Responder
Patient identified correctly ……………………………..Not until pt arrived in CT
Code called correctly…………………………………...Yes
Correct staff responded immediately………………….Charge Nurse did not show up
CNA brought correct items to the room:………………Good team work here.
- Blood Glucose Monitor
- COW
- Dynamap
- Stroke Alert Binder
- Pt’s chart
Patient’s Nurse did the following things:………………Yes, however the time last seen
- Obtained Blood Glucosenormal was not communicated
- Obtained remaining vital signsproperly.
- Remained alert for changes in patient
- Obtained info regarding the time the patient was last seen normal
- Ready to give info to Rapid Response Nurse
Stroke Unit Nurse did the following:…………………..Yes
- Performed NIHSS and Dysphagia Screen
- Assist Rapid Response Nurse
- Accompany Flex nurse and patient to CT
Charge Nurse…………………………………………NO, these things did not happen.
- Called pt’s. PCP to notify of situation
- Call for Transporter
Rapid Response Nurse did the following things:……..Yes, all things done well.
- Obtained info regarding time of onset and symptoms
- Went through exclusion criteria list to determine t-PA eligibility
- Called ED MD to report situation & determine if candidate for intervention.
- Confirm with ED MD that pt will come to ED after CT to await results
- Enter orders for Lab and CT using ED MD’s name as ordering MD
- Start filling out Stroke Alert Record
- Allow Phlebotomist, if present, to draw blood before leaving for CT.
- Take pt to CT. Bring pt’s chart, completed NIHSS & dysphagia screen with you.
- After CT take pt to ED. Give report. Leave chart and forms with patient.
- Notify Shift Supervisor of potential change of bed assignment.
Feedback
UNIT: XX SHIFT: NOC DATE: 4-15-09
RN finding patient called stroke alert appropriately.
Staff came promptly to assist. Extra staff showed up and asked if help was needed, then left if appropriate. That is good teamwork!
The communication between the team members was good, but not consistent. I did hear people asking important questions, such as “What time was the patient last seen acting normally?” “Why is the patient here?” Obtaining information about surgeries, and patient’s weight were good evaluations as well. However, as the code went on, some important facts got changed as they were told by different people. The patient’s name was changed. Perhaps instead of telling a story along with the answer (i.e. “The patient was in the ER all night then came up to the floor at 4 and I came in at 5:50 and found him like this.”) The answer should just be: The last time the patient was seen normal was at 4AM. The time last seen normal I heard during this alert was “10 minutes ago he was seen normal.” That is not true. That is when he was found.
The phlebotomist showed up late. She eventually met us in the CT scanner. Thank you.
The house supervisor showed up. Thank you.
The charge nurse is a crucial piece providing leadership and is needed to make that call to the PCP, informing of what is happening with the patient and what the ED doc is recommending. The Charge Nurse did not attend this alert.
The CT tech was available for CT scan, properly identified the patient, called radiologist to read scans immediately.
The Stroke Unit nurse did not do a dysphagia screen for lack of time, but did report that fact to the ED nurses so that they could do it. That was good thinking. The priority is to get the patient to CT.
The patient’s treating physician was not notified.
The Stroke Alert Paperwork was begun appropriately, thank you.
The patient’s chart did go with the patient to CT & ED, good job.
Report to the ED physician went well.
The ED staff were all responsive to the alert, provided appropriate, timely care, and asked appropriate questions. The ED MD was very cooperative and helpful.
This was a good mock alert. Thank you to everyone!
Feedback
UNIT: 3W SHIFT: Nights DATE: 4-1-09
RN finding “patient” was unsure as to how to proceed. She initially thought she should perform the NIHSS. We talked through the reasons why she should first call a stroke alert.
The mock stroke alert was called correctly and then promptly announced by the operator.
All the staff arrived quickly. There was extra staff that did not need to be there. No CNA arrived (not sure if there was one on shift), so another nurse volunteered to carry out those responsibilities. Very nice!
Most people were not aware of which tasks they were responsible for. The form, “Calling A Stroke Alert” was provided to the Charge Nurse for assistance.
The charge nurse knew her responsibilities well and delegated others as needed. All the appropriate equipment and paperwork were brought to the bedside because of her leadership.
The phlebotomist showed up timely.
The rapid response nurse did not establish himself leadership of the code.
The rapid response nurse rapidly obtained the information needed in order to call the ED MD with a report.
The rapid response nurse did not use the exclusion criteria list to in order know for certain if the patient was ruled out for any reason.
The rapid response nurse was ready to leave for CT without putting orders into the computer. Once reminded, the orders were entered correctly.
The rapid response nurse did not initiate the Stroke Alert chart.
The CT tech was available for CT scan.
The rapid resonse nurse and the 3W nurse worked as a good time taking the patient to ED and giving report there.
The ED staff were all responsive to the alert, provided appropriate, timely care, and asked appropriate questions. The ED MD was very cooperative and helpful.