DID YOU KNOW

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

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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

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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?

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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

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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 1245 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 137 am.
• Time and date of last known well are known as
  11/30/2007 2100, and time and date of discovery
  are known as 1245 a. m

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Scenario 3 Interventional Capabilities

• 57 year old female with sudden onset aphasia and
  dense right sided weakness witnessed by her
  husband at 2200, Husband called the Volunteer
  Fire Department. Squad arrived at pts home
  2255. Arrived at Critical Access Hospital at
  0015. 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 0120.
  Patient arrives in your at ED 0220. Pt with
  NIHSS of 18, and history of HTN. Family is
  driving from Critical Access Hospital and
  expected to arrive in your ED at 0300.
• What happens next?

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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
• QA session with Coverdell nurse to review
  expectations of JC Primary Stroke Certification
  visit

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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

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Questions ????