Stroke Mock Tracer

1. Stroke Mock Tracer JC Stroke Specific Visit Preparation 2008 UH Case Medical Center Cleveland, Ohio Presenter- Chris Sydenstricker RN BSN Quality Nurse

2. Mock Tracer Prep • The UH stroke tracer teams were three teams that included a Neurologist or ED physician, a nurse manager and a quality nurse Each team was assigned an area to trace within a two week time frame - Emergency Department and Intervention radiology - Telemetry floors - The stroke unit and division • An additional mock tracer was done by the Coverdell Nurse as an outside perspective

3. Inpatient Mock Code • Two patients were selected from the inpatient stroke service census for a chart audit and patient tracer • Tracer team used a JC prep checklist and the Inpatient Mock Code form as a guide thru the tracer • The staff was interviewed related to knowledge of how to call a Brain Attack and stroke care interventions • Feedback was shared with the Stroke Quality committee • If patients were not available to trace the Inpatient Mock Stroke scenario would have been utilized

5. Sample Mock Scenarios Scenario 1-Inpatient • A 65 year old male patient is found with right sided weakness and facial droop by a certified nursing assistant while delivering breakfast meal trays. He was previously admitted for angioplasty and kept overnight for observation. He is diabetic and has a history of heart disease. • What happens next?

6. ED Mock Code • A window of time was set aside by the tracer team to evaluate an actual Brain Attack • It was beneficial to evaluate the team “in action” • Utilize Mock Stroke Code ED arrival form as evaluating tool • If a Brain Attack did not arrive within the designated time frame a Mock patient scenario would have been utilized • Triage RN and transfer center staff were interviewed related to 3 hour TPA time window. RN bedside interviewed related dysphasia screening and TPA policy/mixing

8. Scenario 2 – ED • Patient 013 was found on the floor beside the commode by the charge nurse at Starlight Nursing Home on her night rounds at 12:45 am on 12/01/2007. He wasn't able to talk or move, but his left leg was shaking. There were no problems reported with Patient at change of shift. They think that the evening nurse would have seen him between 9 and 10 pm on her rounds. Information was provided by sheet sent from the nursing home. A phone call to the charge nurse does not reveal any further information from the patient's medical chart. ED arrival date and time is 12/01/2007 1:37 am. • Time and date of last known well are known as 11/30/2007 21:00, and time and date of discovery are known as 12:45 a. m

9. Scenario 3– Interventional Capabilities • 57 year old female with sudden onset aphasia and dense right sided weakness witnessed by her husband at 22:00, Husband called the Volunteer Fire Department. Squad arrived at pt’s home 22:55. Arrived at Critical Access Hospital at 00:15. No tech available to perform CT scan. ED physician calls your ED as you are the nearest Primary Stroke Center (50 min. away by air) and patient is accepted for transfer. Life Flight helicopter arrives for transport at 01:20. Patient arrives in your at ED 02:20. Pt with NIHSS of 18, and history of HTN. Family is driving from Critical Access Hospital and expected to arrive in your ED at 03:00. • What happens next?

10. Mock Tracer Coverdell Nurse Visit • Tracer seemed more realistic with an outside evaluator • Coverdell Nurse focused more on the hand off process in each treatment area • Tracer more focused on staff knowledge of process improvement projects- TPA mixing, stroke education , dysphasia • TPA flowsheet developed after tracer to improve hand off process • Q&A session with Coverdell nurse to review expectations of JC Primary Stroke Certification visit

11. Lessons Learned • Outside evaluator very beneficial to JC stroke prep • Incorporate evaluation of ALL National Patient Safety Goals into Mock Tracers • Do chart tracer audits as well as walk arounds to evaluate stroke documentation and stroke care with consideration to National patient safety goals • Involve staff in performing tracers • Focus on hand off from one area to another • Monitor dysphasia screening and TPA prep process in mock tracer

14. Questions ????