Honey, I think your dad had a stroke.
I fear hearing these words over the phone from my mom.
Stroke continues to be the fourth leading cause of death in the United States and the leading cause of disability in Montana. My dad has several medical conditions which put him at a higher risk for stroke: high blood pressure, diabetes, atrial fibrillation (a heart rhythm disorder), he is male, and he is over 55 years old.
I have already talked with my parents about stroke and the steps to take if one of them develops symptoms such as an uneven smile, weakness and/or numbness in one arm or leg, slurred speech, or inability to speak. They know to call 9-1-1 and ask to be taken to the nearest Primary Stroke Center-certified hospital, because each minute a stroke is left untreated the risk of permanent brain damage, disability, and death is increased. The care and treatment a stroke patient receives in the first hours after stroke onset can greatly influence the patients recovery. Primary Stroke Center-certified hospitals have the necessary people and processes in place to provide the best possible stroke care.
The only FDA-approved drug treatment for acute ischemic stroke is tissue plasminogen activator (t-PA). It has to be given within 4 1/2 hours of the start of stroke symptoms, and it has been shown to be more effective the sooner it is administered.
The American Heart Association/American Stroke Association recommends that an acute stroke patient receive t-PA within 60 minutes of arrival to the Emergency Department. Many steps involving many different people have to occur before t-PA can be administered.
When the patient arrives in the ED, a nurse confirms stroke symptoms and calls a Stroke Team. This alerts a pharmacist, lab personnel, CAT scan technician, STAT nurse, respiratory therapist and ED physician to the patients bedside. Next steps involve a medical history screening, physical assessment including a special neurological assessment, CAT scan of the head, IV placement and lab evaluation. A pharmacist has to prepare t-PA, and the ED physician has to explain risks and benefits of t-PA to the patient and family.
As you can imagine, many things can get delayed or go wrong in this process. One way a hospital can work towards delivering the best care to a stroke patient is by obtaining a primary stroke center certification through the Joint Commission, which is the largest national independent hospital evaluation body. The certification was started in 2003 through a partnership between the American Heart Association/
American Stroke Association and the Joint Commission.
Primary stroke center certification requires a hospital to demonstrate it is following best practices for stroke care as recommended by the AHA/ASA study of available research. PSC hospitals are also required to collect and report data on stroke care. They are required to set performance goals and demonstrate performance improvement efforts surrounding this data. The Joint Commission reviews the data and performance improvement efforts yearly with an on-site visit every two years.
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Nurses notes: Immediate stroke treatment essential