May 2025

BHS Stroke

August 2024

Stroke Documentation:

There are 3 parameters that need to be documented for all patients with Stroke symptoms:

Blood Glucose - The blood glucose intervention has been removed. Blood Glucose is to be documented in the vitals going forward.
Last known well time
Neurological Assessment - This was documented in the Cincinnati Stroke intervention before. The Cincinnati Stroke intervention has been removed and the assessment is to be documented in the Neurological Assessment instead. The Neurological assessment captures all the information of Cincinnati plus additional pertinent information needed for stroke documentation. It can be found under the objective assessment tab. See below.

Please note, that this update and reminder are from the direction of Neurology Services at Independence Health System and will be monitored by quality assurance at Butler Ambulance Sevice.

Glucose in Vitals

Last Known Well in Subjective

Neurological Assessment

January 2024

For this calendar year, our performance improvement goal is to improve Stroke Door-to-Needle (DTN) time to 30 minutes at least 50% of the time. We appreciate and value all of EMS efforts to help us improve and make our goal last year. We are again asking for your help and support to help improve care for our patients.

We are asking EMS to help:

· As much as possible getting clear last known well times – 2 areas of opportunity

o (1) early morning symptoms/call (such as LKW -Last known well time 8 am) – we would like confirmation if the patient woke up normal or woke up with symptoms

o (2) nursing facilities – as much as they can encourage the facilities to obtain and give better histories

· As much as possible obtain IV access suitable for CTA imaging for evaluation of large vessel occlusion

o 18 G preferred; minimum 20G

o In forearm or AC; hands cannot be used

o Preferred right arm due to better imaging for flow of IV contrast

Thank you and to EMS for all you do to care for our patients!

Melisse

Melisse S. Maser CRNP

Advanced Neurovascular Practitioner, ANVP-BC

Family Nurse Practitioner, FNP-BC

Neurology Service Clinical Coordinator

BMH Neuro/BMP Neurology