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Presenter’s Disclosures• McCord Smith, MD – none • Beth Watkins, RN – none• James Lugtu, RN, NP – none• David Briscoe, EMT-P – none • Debbie Camp, RN• Genentech Speaker’s Bureau• Coverdell Steering Committee member• Georgia- Stroke Professional Alliance- Past Chair • Tenet Stroke Collaborative- Past Chair • ASLS Instructor Trainer
• Shelley Nichols, RN – none
Organization
•Physician champion• Stroke Coordinator• Stroke Committee•Core Stroke Team• Link to “hub”•Quality Department•Protocols
Collaboration• Internal• Designated point person• Radiology• Pharmacy • Physical Therapy • Quality • Abstractor(s)• ED physicians/staff • Hospitalists • Cardiology
Collaboration• External• Georgia Coverdell Acute Stroke Registry• American Heart Association• Georgia Department of Public Health• Georgia Office of EMS• Georgia Hospital Association• Georgia Stroke Professional Alliance• The Joint Commission• Vendors
Build the process• Coverdell Registry/data• Abstractor selection and training
• Telemedicine• Establishing a project plan• Physician credentialing• Physical infrastructure• Grants
Benefits of Coverdell Registry• Monthly registry-wide telephone conference calls with
participating hospitals, EMS agencies and GCASR staff• “Kickoff” workshop for new participants• Annual regional data abstraction training workshops• Quarterly GCASR newsletters• Annual meetings to exchange best practices• Quality improvement consultant to work with hospital staff on-site
or by telephone• Encouragement to hospitals to network with one another• Great resources and mentoring for hospitals needing specific stroke
related information• Georgia Coverdell Champion Hospital of the Year Awards• Opportunity to contribute to improve stroke care quality statewide
Education • Staff & Local EMS providers• ASLS• Targeted in-services• Transfer process (Coverdell transfer form)• Receiving hospital process
• Mock drills• Continued support
• Community• Health fairs• Industry• Schools• Churches
Prepare for the VisitDevelop ChecklistLetter of Intent as remote stroke treatment center from
hospital CEOAppoint Medical Director for stroke programPrepare protocols (preprinted and electronic) Prepare pre-written stroke order set in collaboration with Hub
HospitalWrite policy on stroke notification system, with expected
response timesDevelop transfer protocolWork with other departments (Lab, Radiology) to prepare
protocols
Continue the plan• EMS feedback form (Coverdell) (need to add
form)• Hospital internal feedback• Marketing
Building Relationships• Sharing dashboards/data• EMS workroom• EMS banquet• EMS to stroke committee meeting• “Thank you” for caring for our patient/for bringing the patient to
us• Straight to CT scan• Talk about an interesting patient• Grand rounds correlate symptoms to scan• Physician involvement • Ask questions to encourage• Collaboration and collegiality• Identifying stroke save • Certificate of appreciation “great job” in the field
Building Relationships• Learn names
• Report directly to neurologist
• Use the medics to teach
• ASLS with nurses and medics
• Physical presence in the ED and on the nursing unit
• EMS Provider: National EMS• Date: 05/20/2014• Crew: Eddie Dixson & Kelly Glover • On Scene to Transport Time: 15 min• CPSS, MEND EXAM, and Last Know Well documented by EMS!
Great Job – communication is key to excellent stroke care!• ED Physician: Brandon Hicks, MD• Neurologist: McCord Smith, MD• ED RN: Casey Shields, RN• NCCU RN: Reghan Dagley, RN & Marie Saylor, RN• Last Known Well: 12:15• Arrived: 13:19• NIHSS on arrival: 6• Door to CT: 5 min• Door to Needle: 58 min• NIHSS at DC: 1• Patient was discharged home
EMS STROKE UPDATE
Excellent Stroke Care
Maintaining the Momentum Major responsibility of the Stroke Champions
Meeting and sustaining the requirements for following evidenced based practices to improve outcomes for patients entering their healthcare facility.
Program Engagement Continues
• Success of the Stroke Program requires:• Administrative buy-in • Stroke Medical Director• Stroke Coordinator• Interdisciplinary Team has Stroke Champions
Hub & Spoke Partnership• Credentialing • Mentoring/Mock Drills• Policy/procedure updates• Commitment to Improving Outcomes• Trusting Collaborative Relationships• Exchanging Professional Experiences• Clinical Expertise / Evidenced Based Practice
BELIEF THAT YOU CAN & DO MAKE A DIFFERENCE
Tips to Success• Stop reinventing the wheel• Share resources, best practices, and what didn’t work• Collaborate, Network connect with someone new today• Be accessible to the Team• Administration, Physicians, Staff and Patients
• Let the owners of the process make the changes• Avoid negative verbiage, restate it in a positive manner• Focus on improving a process not blaming a person
Stroke is a TEAM sport have fun and enjoy what you do!
Stroke Champions:Sustain the Infrastructure • Maintain State Designation• Educate (Staff/Physicians/Patients)• Policy & Procedures update• Updated Guidelines• Data Abstraction & Analysis (Coverdell/GWTG)• Quality Improvement (Concurrent RCA)• Outreach (EMS/Community/Physicians)• Networking/Collaboration (GA-SPA, AHA/ASA)• Professional Development (SCRN/CNRN/ENA)• Research (GA-StrokeNet)
Quality Improvement • Regulatory Preparation: State, ATSC, PSC, CSC• Know the strengths and weakness of the program.• Mock drills, participate in Stroke Alerts, daily rounds
• Manage data (concurrently if possible)• Prioritize PI projects• (RCA: root cause/rapid cycle analysis).
• PDCA- then recheck, recheck, recheck • Patient & Family Experience• Celebrate Successes!
Stroke Education…………Forever………• EDUCATE (ASLS/FAST)• ED, ICU, M/S Tele, Rehab, RRT, Supervisors, Ancillary Support,
Lab, Radiology, Volunteers, All Staff.• Off Services- OB, orthopdedics, surgery, cardiac, oncology, all
patients & visitors • Competencies: web based or check off (test and verify)
• Community/Family/Self• Schools, churches, businesses, assisted living, ECF/LTAC, Health
Fairs, Community events- sport events, concerts, festivals
• 911 Dispatch/EMS/Paramedic/Fire Fighters
Continue to Advance the Program• Professional Development• Obtain Certification in specialty: SCRN, CNRN, ASLS
Instructor, CEN, CPHQ, CHCQM, CNS, RN-BC• Participate in Professional Organizations: AANN,
AHA/ASA, NSA
• Networking & Collaboration• GA-SPA, Conferences, Strike out Stroke, ASLS classes,
Health Fairs, Schools, Businesses
• Research• Publication, present at local, state, regional & national
conferences, participation in GA-Net
AHA/ASA Partnership• Legislative Advocacy• National Expertise/Guidelines• International Stroke Conference (ISC)• Local/State Mentoring• Coverdell/GWTG Partnership• Target Stroke Honor Roll • Silver/Gold Plus Award’s • Mock Regulatory Survey’s• Community Education
Georgia Coverdell Partnership• BI-Monthly Teleconferences• University of Miami’s Advanced Stroke Life Support
(ASLS) course free to participating hospitals • Provides QI consultant to hospital staff• Re-abstraction inter-rater reliability to monitor data
abstraction accuracy• Quarterly Newsletter with hospital highlights • Educational Resource for hospitals
Georgia Stroke Professional Alliance (GA-SPA)
Mission Statement
The Georgia Stroke Professional Alliance is Committed to Stroke Prevention and Optimizing Stroke Care through
Professional Networking and Education
July 2009
GA-SPA Partnership• Quarterly meetings• Education for Stroke Champions• Community education• Strike Out Stroke• Research (ISC, AANN, GA-Net)• SCRN/CNRN Review Courses• ASLS Instructors• Mentoring• List Serve• Website
Successful Sustainability Reminders• Stroke Champions- Never a one person job• It’s ALL about Partnerships/Networking• Know your data-Opportunities• Transparency to staff and community• Celebrate Success “every day”• Market Program to Community, Physicians, Staff• Patient stories• Education events• Sport events, Festivals
Stroke is a TEAM sport have fun and enjoy what you do!
Accreditation Choices
GA - State Certification (RTSC)
• DNV-Det Norske Veritas• HFAP- Healthcare Facilities Accreditation Program• TJC- The Joint Commission State Certifications
THANKS to a GREAT TEAM• Dr. McCord Smith (St. Mary’s)• Montez Carter & Beth Watkins (Good Samaritan)• Kerrie Krompf & James Lugtu (GA Coverdell Registry)• Joyce Reid (Georgia Hospital Association)• Chris Threlkeld, David Briscoe (EMS Experts)• Keith Wages & Ernie Doss (State OEMS)• Dr. Michael Frankel & Shelley Nichols(Grady Memorial
Hospital)
To each of YOU for being here today !!!