Purpose:
The Stroke Program manager (SPM) collaborated with the Rapid Response Team Nurses (RRTRN) to develop a facilitator process for patients in the intensive care units (ICU) presenting with stroke symptoms. The SPM developed a process to include activation of the Rapid Response Team (RRT) which included dedicated RRTRNs for all non-ICU stroke alerts (SA). This new SA improved care coordination, patient outcomes and improved the nurse work environment. The SPM identified the need for a similar SA process in the ICUs. Jointly, the SPM and RRTRNs developed a process to expand the RRTRN role to facilitate SAs in all ICUs.
Methods:
The SPM proposed involvement of the RRTRNs in the SA for ICU patients to the RRT Subcommittee with the support of nursing leadership. This new process would involve the RRTRN responding to all SA activations in the ICU. Care coordination shifted to a leadership couplet: the RRTRN and the ICURN. Implementation included specialized education orientation and scripted materials. The ICU RNs were educated on this unique process. This cutting edge process was incorporated into the RRT matrix to accommodate simultaneous RRT and SA alert activations. The RRTRNs provided efficient care coordination, dependable documentation, enhanced patient outcomes and support to the ICU RN.
Evaluation:
Utilizing RRTRNs as stroke facilitators bolstered the stroke alert process in the ICUS. When a patient exhibits sudden stroke like symptoms, the RRTRNs bring their expertise to the bedside, specifically by achieving the stroke metrics. ICU patients already have complex needs and the addition of a stroke complication is not a common occurrence. Creating this small group of “stroke experts” outside the ICU transferred easily into the ICU setting. Since its implementation, the facilitated 60 ICU SA focusing on the aspects of stroke care while the ICU nurse continues to maintain the critically ill patient.
Implications for Practice:
ICU are often very specialized in the care they deliver, but a stroke can traverse all of those specialties. Developing a small group of experts in stroke, provided consistency, support, and overall better care and outcomes for a patient when every moment counts. Utilizing the existing group of RRTRNs was fiscally sound as well as practical.
Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years
