1. Follow protocol. The Joint Commission issued 10 measurable standards for hospitals to meet in order to be recognized as a primary stroke center. Woodland was officially recognized by The Joint Commission by exceeding standards set by the American Stoke Association, such as standard treatments of deep vein thrombosis and anti-coagulation therapy. The Woodland medical staff looked at those standards and found it was only meeting those standards 50 percent of the time. It is now consistently performing at approximately 90 percent.
“We want to make sure those core measures are met every single time,” Ms. Porter says. “For example, patients become inactive, causing blood clots to form. So we give medication, but the most common thing [we use] is compression stockings, which squeeze your leg up and down constantly. We measured our compliance to the protocol, and now it’s a preventative measure we use for all of our patients.”
2. Focus on timeliness. The staff at Woodland focuses on not only following protocol but doing so in a timely manner. For example, Ms. Porter explains that medical staff members work quickly to obtain CT and lab results within 45 minutes after they arrive at the hospital for the physicians to review and see if the stroke patients qualifies for tissue plasminogen activators (tPA), a clot busting medication that is given to stroke patients as long as they qualify and arrive at the hospital within three hours.
3. Save time and avoid mistakes by using electronic records. More hospitals are using electronic health record systems to chart patients’ progress or record medical history. Woodland uses Cerner’s EHR system to make sure nurses and physicians don’t mistakenly miss steps that relate back to stroke core measures. For example, the EHR system has pre-checked boxes to make sure patients receive medication that prevents blood clots. The pre-checked boxes also ensure they are seen by therapists for physical and occupational therapy, and staff members check to ensure they are able to swallow.
“We have pre-done everything in the computer,” Ms. Porter says. “It’s prompt, and everything is there to remind them.”
4. Educate patients and the community. Woodland emphasizes the importance of educating others about signs and symptoms of stroke and how important it is to receive treatment immediately. Ms. Porter often sees the effects of patients waiting days to have their strokes treated.
“I’ll visit schools, nursing homes, rotaries, senior centers and train general ambulance companies as well to just get the message out there and let them know how to deal [with a stroke],” she says. “I had a patient that dragged her leg around for three days because she thought it was asleep. [Patients] don’t understand it’s a neurological deficit.”
5. Provide follow-up care and rehabilitative services. Nurses at Woodland work around the clock to make sure that patients not only receive care while they are in the hospital but are also cared for after being discharged. Staff members go over education about hypertension and lowering blood pressure to a stable level. They also remind patients to take their prescribed medications and emphasize the importance of diet and exercise.
Lasting effects of a stroke may not be immediately remedied with a prescription, and the staff at Woodland recognizes continuity of care is key to the patient’s success and rehabilitative services are a fundamental part of stroke care. Stroke patients are taught how to walk again if they have an affected gait and receive speech and occupational therapy.
