News | Published October 7, 2014

Primary Stroke Center designation, refined stroke practices keeps patients healthy

Occurring once every 40 seconds in the United States, stroke is the fourth leading cause of death in America. Because a stroke can happen to any person at any time, many healthcare facilities are making stroke care a top priority.

When someone is having a stroke, time is of the essence. A stroke occurs when vital blood flow and oxygen to the brain are cut off. Getting emergency medical treatment at the first sign of stroke can help save a person’s life.

Recently, Mount Nittany Health was awarded Primary Stroke Center advanced certification through The Joint Commission, in a continued attempt to provide quality stroke care to patients.

“In 2012, a new act was passed stating that emergency medical service units have to take patients, who appear to have signs of a stroke, to a medical center that is certified as either a Primary Stroke Center or a Comprehensive Stroke Center,” said Susan Maynard, MS, RN-BC, CCNS, CCRN-CMC, stroke nurse coordinator, Mount Nittany Medical Center. “Although stroke care has always been a top priority, this act allowed us to work toward refining our stroke care practices and achieving designation.”

At the first sign of a stroke (see symptoms listed below), individuals should call 9-1-1 and wait for trained emergency medical services (EMS) personnel for transportation to an emergency department. “The EMS component is critical,” said Maynard. “If a patient is thought to be having a stroke, blood is drawn while on the ambulance, and a call is made to the Medical Center. When that call comes in, we begin immediately preparing for the patient’s arrival.”

Preparation includes making sure the CT scanner is available for the patient and preparing a nurse and physician team.

The blood is drawn to help rule out other medical issues besides stroke, and the CT scanner is used to check for bleeding in the brain, which could mean a hemorrhagic stroke.

“There are two main types of stroke: hemorrhagic and ischemic. Hemorrhagic is marked by bleeding in the brain and an ischemic stroke is caused by a clot,” said Maynard.

Although ischemic strokes are much more common— occurring in approximately 85 percent of stroke patients— it can be much harder to detect than a hemorrhagic stroke.

If an ischemic stroke is presumed, tissue plasminogen activator (commonly referred to as TPA) can help breakdown the clot.

“Ideally, TPA should be given within the first three hours of the onset of symptoms,” said Maynard. “However, this can be tricky because sometimes the last known time that the patient was normal may have been several hours before arriving at the emergency department.”

For patients who do arrive at the onset of stroke, Mount Nittany Medical Center has an excellent track record for administering TPA in a timely fashion. Recently, the Medical Center was recognized as having the fastest “door to needle” time among select area hospitals, meaning the clot-busting TPA was administered in less than 40 minutes.

Another way in which Mount Nittany Medical Center is providing high quality stroke care is through the use of collaborative telemedicine technology with Penn State Hershey Medical Center. Through real-time, remote audiovisual access, the emergency department physician at the Medical Center can consult directly with a neurologist or neurosurgeon from Hershey.

“It’s like having a neurologist right in the room,” said Maynard. “The neurologist and the physician can provide immediate assessment to the patient, discuss potential treatment options, and determine the best next steps.”

Hershey, because of their advanced capabilities of neurological intervention and having neurosurgeons on the medical staff, has Comprehensive Stroke Center certification from The Joint Commission.

“With our Primary Stroke Center designation, telestroke capabilities, stroke-oriented order sets for physicians, you might think this is the end-goal, but in reality, it’s just the beginning. As we should be, we’re now held to the high standard of continuing to offer advanced stroke care to our patients,” said Maynard.

And stroke education is not just for the nurses and physicians, although many clinicians complete specialized training. For general staff, all employees are required to test their knowledge regarding stroke symptoms on a yearly basis. In addition, reminder cards about common stroke symptoms are placed throughout physician offices.

“Our goal is to educate more people to understand the symptoms and the urgency that is associated with stroke,” said Maynard, who notes that approximately 30 to 40 stroke patients are treated at the Medical Center each month. “Stroke is a real issue in our area, and it can happen to anyone at any time. We have to be aware.”

The acronym FAST can help to recognize the signs of a stroke and remind you to act quickly.

F- Face drooping: Ask the person to smile. Does one side of the face droop or is it numb?

A- Arm weakness: Ask the person to raise both arms. Does one arm drift downward? Is one arm weak or numb?

S- Speech difficulty: Ask the person to repeat a simple sentence. Is speech slurred, are they unable to speak, or are they hard to understand?

T- Time: If the person shows any of these symptoms, even if they go away, call 911 and get them to the hospital immediately.

Beyond this acronym, you should be aware of sudden numbness or weakness of the leg, sudden confusion or trouble understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, or sudden severe headache with no known cause. Make sure you’re also marking down the time that these symptoms started.

For more information about the comprehensive stroke services provided at Mount Nittany Medical Center, visit mountnittany.org.

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