Stroke Program November Newsletter!

NOVEMBER 2021

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No One Left Behind...

Extended Window for Alteplase Administration up to 9 hrs from LKW or Wake-Up Strokes for AIS Patients - Plan:

Background: Up until recently, it was recommended that stroke patients only receive thrombolytic alteplase if it could be administered within 4.5 hrs from their last known well. After this time, or for those individuals who wake up with stroke symptoms with no definitive last known well, there was limited evidence supporting the use of intravenous thrombolytic for acute intervention.

The current evidence now suggests that patients with an acute lesion on DWI imaging may be eligible to receive tPA up to 9 hrs from last known well or upon waking up with a stroke (e.g., WAKE-UP Trial). This practice is now a Class IIa recommendation based on AHA's most recent Stroke Guidelines.

Plan: Starting next week, we will begin using the "Extended Window for IV Alteplase Workflow" for eligible patients (link). Although this workflow is not expected to be frequently needed, it is suspected that it may have a profound impact on those few stroke patients who would otherwise not be eligible for acute stroke intervention. Patients who meet inclusion criteria will have an MRI following advanced CT imaging to determine if they are eligible for this intervention.

Go-Live Date: Monday, November 15th

Farewell Spotlight

Sidonie Moses, Accreditation Coordinator, MSN, RN, CJCP

Since 2013, Sidonie has worked alongside our team helping us facilitate site visits, intra cycle calls, and other regulatory related activities. Recently, she shared her upcoming plans to retire from the health system on October 30th and therefore we wanted to take a moment to highlight her hard work and discover what she has planned next.

How did your role impact the stroke the program?

I support processes to ensure our continued designation for providing optimal care of the stroke program by teaming up with leadership to ensure a consistent approach to care, reducing variations and the risk of errors.

Looking back, what was the stroke program TJC visit experience like?

I was proud of the staff's knowledge regarding caring for our complex stroke patients and the surveyors recognition. This was evident by the many accolades they provided during the survey. This included comments regarding best practices and processes the program could share with other organizations. The manner in which our staff interacted with the surveyors left no doubt that our practices are aligned with current Clinical Practice Guidelines (CPGs).

Name one thing about your role that may surprise people.

I have visited every clinic in the Health System's Kansas City division including clinics in Atchison, St. Joseph, and Topeka.

If you could switch places with one person for a week, who would it be?

The Poet Laureate Amanda Gorman.

If you could witness any historical event, what would you want to see?

The "I Have a Dream" speech by Martin Luther King Jr.

What's next for you? I am going to work in long term care. I look forward to learning new skills and gaining new knowledge.

What's New?

Update: Alteplase Shortage

There is a shortage of the transfer device that accompanies the alteplase 100mg vials. Genentech has recommended that we prepare staff to begin using the 50 mg vials if the shortage impacts our supply. For the time being, we believe that we have enough 100mg vials to last for at least the next month.

Please keep an eye out for updates from the stroke program with details regarding this shortage and instructions for how to administer alteplase using the 50mg vials.

The New(ish) Kid in Town: Tenecteplase

Tenecteplase, AKA TNKase, is another thrombolytic drug (think alteplase with a few differences) approved

for use in the reduction of mortality associated with Acute Myocardial Infarction. Recently, healthcare providers across the country have been exploring the usability of TNKase for Acute Ischemic Stroke Intervention. Here are a few things you should know about it:

TUKHS is involved in the TIMELESS Trial (Investigation into the safety & efficacy of Tenecteplase vs. placebo in stroke patients 4.5 hr - 24 hr from LKW)
Tenecteplase is NOT currently administered at TUKHS for AIS intervention
TUKHS has started receiving transfer patients who have been administered Tenecteplase at an outside facility prior to transferring. Tenecteplase is given as a one-time, 0.25 mg/kg bolus that should be completed prior to leaving the transferring facility with EMS.
Managing Patients Post-Tenecteplase Administration: Management should match the care provided to patients following alteplase administration
Benefits of Tenecteplase vs Alteplase:

Less expensive
Easier to prepare than Alteplase, leading to:
Reduced door to needle times
Reduced transfer & EVT treatment times
No difference in early safety & clinical outcome measures

For more information regarding Tenecteplase, click here

$$$ Auxiliary Award $$$

As identified by TJC, it is best practice to obtain an accurate weight (as opposed to estimating) prior to administering an IV thrombolytic to the acute ischemic stroke patient.

The stroke program has received one of the limited financial awards from the KU Auxiliary Fund. The money awarded will be dedicated to purchasing a Patient Transfer Scale that will be used during Acute Stroke Responses. This transfer scale will allow our team to accurately & easily weigh patients. More news to come over the next few months...

Patient & Community Resources

Classes & Events

Stroke Health Risk Assessment

Stroke Education Series

Internal Resources

Resident Handbook

Clinical Practice Guidelines

COVID-19

S.H.E.E.P

Handoff Videos & Tools

Data Central

Dashboards

Stroke Interventions

Acute Stroke Response Team

Performance Measures

Achievements & Awards

Reminder: Calling Tier 2 Stroke Activations

Acute Stroke Activations have been split into a 2-tier system since January of this year. A Tier 2 Activation is called when a transfer patient has had a recent stroke but is unlikely to be eligible for acute stroke intervention. It is still important that a stroke activation be called to ensure that the patient receives stroke specific assessments (e.g., NIHSS & SDS) & treatments (e.g., aspirin, statins, etc.) in a timely manner. ASRT should always respond to these activations in ED Hall 72. For more information about Tiered Stroke Activations, click here.

Attempts were made to devise a plan to activate these patients once they arrive at their assigned rooms, but due to resource and staff limitations, no safe plan was able to be developed. As more resources become available, we will reassess this system to determine if there is a way to activate these patients on the unit that they are admitted to.

The Fast & the Furious!

Congratulations to the team members who achieved the below fastest intervention times!!!

Your opinions matter! Please complete the BE FAST Survey and share your recent experience with a stroke intervention and/or activation. To provide other general feedback please email us.

This Month's Quiz!

And the Winner is...

Congratulations to Dr. Laith Maali for winning the September's Quiz $10 coffee gift card drawing!! Chaeli Stenuf will be in contact with the winner for more info on how to retrieve their prize.

Question: What component of the below consent is missing? See Consent Here.

Answer: Type of Representative Consenting.

DON'T FORGET, every month, everyone who correctly answers the quiz question will be entered in a drawing to win a $10 coffee shop gift card! Seems like an easy way to stay caffeinated during those particularly exhausting shifts.

Quiz Question: A Tier 2 stroke activation can be called for ____ & should be activated to _____.

Select the correct answer below:

All strokes unlikely to qualify for acute intervention; ED Hall 72

Select

Transfer strokes unlikely to qualify for acute intervention; ED Hall 72

Select

All strokes unlikely to qualify for acute intervention; inpatient room

Select

Transfer strokes unlikely to qualify for acute intervention; inpatient room

Select

“Those who say it cannot be done should not interrupt those doing it.” - Chinese proverb