ED Stroke Tracer

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Security

• What are the signs and symptoms of stroke?

  Yes

  No

  N/A

• If the patient presented with these symptoms, what would you do?

  Yes

  No

  N/A

Registration Desk

• What are the signs and symptoms of stroke?

  Yes

  No

  N/A

• If a patient presented with these symptoms, what would you do?

  Yes

  No

  N/A

Environmental Services

• What are the signs and symptoms of stroke?

  Yes

  No

  N/A

• What would you do if someone presented with these symptoms?

  Yes

  No

  N/A

Triage Nurse

• What are the demographics of the ED?

  Yes

  No

  N/A

• What is your triage system? Who is in your area? What is the role of the triage nurse?

  Yes

  No

  N/A

• What is your average triage time per patient?

  Yes

  No

  N/A

• How long does it take to receive a stroke evaluation by MD/PA/NP?

  Yes

  No

  N/A

• Do you have a written policy discussing diversion?

  Yes

  No

  N/A

ED Tech

• What is the role of the ED tech?

  Yes

  No

  N/A

• What are the signs and symptoms of stroke?

  Yes

  No

  N/A

• How do you notify your stroke team of a stroke patient?

  Yes

  No

  N/A

• Who are the members of the stroke team?

  Yes

  No

  N/A

• How long does it take the stroke team to arrive to the ED?

  Yes

  No

  N/A

Staff RN

• Do you take care of stroke patients?

  Yes

  No

  N/A

• What stroke education have you had?

  Yes

  No

  N/A

• How many hours of stroke education are your required to have annually?

  Yes

  No

  N/A

• What competencies have you had this year?

  Yes

  No

  N/A

• Are you evaluated after orientation?

  Yes

  No

  N/A

• Are you familiar with our stroke measures?

  Yes

  No

  N/A

• How are you informed of your stroke measures?

  Yes

  No

  N/A

• Who is the stroke champion in the ED?

  Yes

  No

  N/A

• What clinical practice guidelines are used in your stroke policies?

  Yes

  No

  N/A

• If a potential stroke patient is coming to the ED via EMS, are you notified prior to arrival?

  Yes

  No

  N/A

• How is feedback/education provided to EMS?

  Yes

  No

  N/A

• Who is your base station operator?

  Yes

  No

  N/A

• Are stroke patients kept NPO?

  Yes

  No

  N/A

• Are you trained to administer a swallowing screening?

  Yes

  No

  N/A

• Is the swallowing screening a validated screening?

  Yes

  No

  N/A

• Explain how the team is notified when a patient presents with stroke symptoms?

  Yes

  No

  N/A

• How long does it take for the patient to be assessed by the ED providers??

  Yes

  No

  N/A

• Is it difficult to get neurology here to see the stroke patient?

  Yes

  No

  N/A

• What assessment do you use to quantify stroke symptoms?

  Yes

  No

  N/A

• Who performs this assessment?

  Yes

  No

  N/A

• Do you use stroke order sets?

  Yes

  No

  N/A

tPA

• What is your goal for Door To Needle time?

  Yes

  No

  N/A

• What is our current DNT?

  Yes

  No

  N/A

• Have you had a competency regarding tPA administration?

  Yes

  No

  N/A

• What is your tPA on formulary?

  Yes

  No

  N/A

• Do you consider tPA to be a high risk med? Does it require a double check by another RN?

  Yes

  No

  N/A

• Is consent obtained for tPA?

  Yes

  No

  N/A

• What are contraindications to IV tPA?

  Yes

  No

  N/A

• What are the blood pressure parameters for IV tPA?

  Yes

  No

  N/A

• What can you do to bring down an elevated bp?

  Yes

  No

  N/A

• Who writes orders for IV tPA?

  Yes

  No

  N/A

• What is the standard dose of IV tPA?

  Yes

  No

  N/A

• What is the max dose of IV tPA?

  Yes

  No

  N/A

• After drawing up the does, do you waste excess tPA? Why?

  Yes

  No

  N/A

• Does the same stroke process exist on nights and weekends?

  Yes

  No

  N/A

• Do you weigh your patients to obtain their weight?

  Yes

  No

  N/A

• Who administers the bolus and dose of tPA?

  Yes

  No

  N/A

• Is there a policy for vital signs and neuro checks when a patient receives IV tPA?

  Yes

  No

  N/A

• Where do you document vital signs and neuro checks for patients receiving IV tPA?

  Yes

  No

  N/A

• What are you looking for as potential adverse reactions to tPA?

  Yes

  No

  N/A

• What would you do if your patient receiving IV tPA had a new headache, neuro deterioration, or s/s of increased ICP?

  Yes

  No

  N/A

• Could your ED handle more than one tPA case at the same time?

  Yes

  No

  N/A

• Where are patients admitted who have received IV tPA?

  Yes

  No

  N/A

• When there is a decision to admit, how are orders obtained?

  Yes

  No

  N/A

• How do you give patient report?

  Yes

  No

  N/A

• Is it documented anywhere?

  Yes

  No

  N/A

• How do you treat stroke patients who are ineligible for IV tPA?

  Yes

  No

  N/A

Imaging

• Do you accompany the patient to CT/MRI?

  Yes

  No

  N/A

• What is the expected TAT for CT results in a stroke patient?

  Yes

  No

  N/A

• Who reads the CT?

  Yes

  No

  N/A

• If the patient were pregnant, would she go tot CT/MRI?

  Yes

  No

  N/A

• What if the CT scanner is occupied?

  Yes

  No

  N/A

Lab

• What is your goal for Lab TAT?

  Yes

  No

  N/A

• Explain your process for drawing labs.

  Yes

  No

  N/A

• Describe your process for handling abnormal lab specimens for stroke patients.

  Yes

  No

  N/A

ED MD

• What are you doing for newer anticoagulants (xarelto and pradaxa)?

  Yes

  No

  N/A

• Are you required to receive annual stroke education?

  Yes

  No

  N/A

• Can you explain your stroke process?

  Yes

  No

  N/A

• What is your role in the stroke process?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Do you have a policy for patients who go to IR?

  Yes

  No

  N/A

• How do you handle TIA patients?

  Yes

  No

  N/A

General

• Can you name 2 National Patient Safety Goals?

  Yes

  No

  N/A