Code Stroke Process 3. MD evaluation < 10 minutes Brief neuro exam Confirm Last Known Well Time (LKW)

Code Stroke Process 4. Notify UC Stroke Team < 15 minutes 513-844-7686 Patient demographics POC Glucose LKW What’s wrong?

Code Stroke Process 5. Patient to CT scan < 25 minutes 6. CT Interpretation < 20 minutes (45 minutes from start of Code Stroke) Hemorrhage → consult Neurosurgery 513-981-2337 (981-BEDS) No Hemorrhage/Acute Ischemic Stroke (AIS) → evaluate if patient is a candidate for TPA

Code Stroke Team CODE STROKE Responders = Code Blue Team + ED Charge RN ED Charge RN to assist with baseline NIH ICU RN will respond to floor 2 and above CVU RN will respond to 1st floor and below ICU or CVU & Primary RN will accompany bedside nurse to CT (SBAR) PCU RN will document

Code Stroke Team Roles Primary RN Collects blood sugar Obtains VS Determines LKW SBAR to team Transports to CT with ICU RN

Code Stroke Team Roles Unit Charge RN ED Charge RN Completes NIHSS* Places patient on Zoll monitor Notifies attending/consulting MDs Notifies family ED Charge RN Completes NIHSS* Ensures compliance with stroke algorithm & time frames * PCU RN will document NIHSS assessment as ED RN does not have inpatient CarePath access

Code Stroke Team Roles ICU/CVU RN Hospitalist Transports pt to CT with primary RN Reports labs & CT result to hospitalist If ordered, starts tPA (Alteplase) within 60 minutes If hemorrhagic, Consults Neurosurgery Hospitalist Evaluates patient within 10 minutes Reviews glucose result Provides orders for labs, CT Calls UC Stroke Team within 15 minutes Reviews inclusion/exclusion criteria Reports labs & CT result to UC Stroke Team

Code Stroke Team Roles PCU RN Clinical Administrator PCA Documents events in CarePath using Code Stroke Narrator Clinical Administrator Ensures MD call to UC Stroke team within 15 minutes Facilitates patient transfer PCA Brings glucometer & WOW to room Brings patient’s softchart and facesheet to room Rounds on other patients

Code Stroke Team Roles Radiologist Pharmacist Calls CT result to primary RN Pharmacist Prepares tPA (Alteplase) and delivers to ICU within 15 minutes of CarePath order Reviews dosage with ICU RN at bedside prior to administration

Code Stroke - Documentation MUST Document in a Code Stroke: Last known well (LKW) Blood Glucose Full set of vitals Full NIHSS – in EPIC flowsheet “What’s wrong?”...why did you call a Code Stroke??