Using the acute ischemic stroke pathway
One of the pathways enclosed in this issue of ED Nursing was adapted from the University of Texas, Houston stroke team. The pathway was designed after collaboration by nurses from eight stroke centers. These centers all participated in the pivotal National Institute of Neurological Disorders and Stroke tissue plasminogen activator (t-PA) study and included the University of Cincinnati; the University of California, San Diego; the University of Texas, Houston; Long Island (NY) Jewish Medical Center; Henry Ford Hospital, Detroit; Emory University School of Medicine, Atlanta; University of Virginia Health Sciences Center, Charlottesville; and the University of Tennessee, Knoxville.
Many of these nurses have worked for more than 10 years perfecting the clinical treatment pathway for the administration of t-PA after acute stroke. As illustrated in the pathway, the most important element is time. (See "Protocol Guidelines," inserted in this issue.) All patients who present with acute focal neurologic symptoms should be evaluated and treated as emergency patients who are having a code blue, but in this case the nurses call it code stroke.
Emergency response teams, including emergency medical services, ED nurses, ED physicians, and organized stroke teams, need to be constantly focused on rapid transport, triage, and evaluation to overcome time barriers and successfully treat patients within the first three hours of their stroke. Although each hospital system is unique, the nurses involved say that based on their collaborative experience, this treatment pathway provides realistic goals that emergency departments and stroke response teams can achieve.
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