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Cedars-Sinai Medical Center

By Taryn Fort

Part Five: Further Obstacles (Read More : Parts 1 & 2, Parts 3 & 4)

Patient aggregation was an initial challenge, but Paletz and the team developed a strong relationship with the director of admitting. “We were very lucky to have our director of admitting, Therese Carrabine, on board to make aggregation happen. This was a huge success for us.”

The team also faced problems with lipid panel blood tests, which measure lipids and fatty substances used as a source of energy by your body and can be used as an indicator for prescribing a cholesterol-lowering drug. Instead of getting discouraged, they turned the problem into opportunity by creating web alerts for physicians. “When they sign on to our electronic medical record they get a ‘gentle suggestion’ that as per the American Heart Association/ American Stroke Association guidelines, they consider ordering a lipid panel for this patient or if the panel was already done but was elevated, that they consider ordering statins for this patient,” said Paletz. The team had huge success with the move, including an improvement in compliance.

The Joint Commission’s measure set recommends a dysphagia screening be performed on all ischemic and hemorrhagic stroke patients prior to receiving anything by mouth. Because education must be documented, this proved to be an area of inconsistency for the team. “We felt (it) needed to be more specific to stroke and more consistent in the way nurses were doing it across the medical center,” said Paletz. “This easy swallowing screen was very well received and simple to use. I developed a new form that goes in to every patient’s chart so that their stroke education is clearly documented, their personal risk factors are addressed and the five new Joint Commission education measures are covered with every patient and their family members or caregivers where appropriate.”

Part 6: Looking Back 

Once a program is certified, The Joint Commission requires regular data submissions and performance summaries for ten measurement activities including dysphasia screening and patient discharge on a cholesterol-reducing medicine. Therefore, the stroke team never stops educating and pushing staff to be trained and ready for stroke patients. “Today, the hospital staff, especially nursing, continues to be actively involved in improving patient care by asking questions, requesting assessment skill supervision, discussing individual cases, and notifying us when a stroke patient has special needs that we can help to meet,” said Tarlow. “They also have requested that we continue regular in-services to keep them current with "best practices" in stroke care.”

To say that Palestrant and Paletz are pleased with the outcome is an understatement. “I'm very proud of our stroke team and the hard work it took to get certified, it was a huge undertaking,” he said. Not only did the team pass the surprise visit, Paletz noted that “the surveyor was very pleased with our work and very pleased with the feedback from the patients and their families.”

Paletz admits that showcasing the program and performing well during the survey are what caused most sleepless nights. “I wish I had a bit more confidence in the fine work we were doing and stopped second-guessing myself. I knew we were providing excellent care to our patients, and I was and continue to be very proud of the work we do here,” she said. “In the end - it was actually a great experience.”

She advises other hospitals and programs to network with colleagues. “That has been the one of the greatest parts of this process -- making connections from all over the country, meeting at conferences and events and sharing our successes and challenges.”

Once a program is certified, The Joint Commission requires regular submissions of data reports and summaries of 10 performance measurements:

  • Deep vein thrombosis (DVT) prophylaxis
  • Discharged on antithrombotics
  • Anticoagulation therapy in patients with atrial fibrillation
  • Thrombolytic therapy administered
  • Antithrombotic therapy by end of second hospital day
  • Discharged on cholesterol-reducing medication
  • Dysphagia screening
  • Stroke education
  • Smoking cessation/advice/counseling
  • Assessed for rehabilitation

“My family jokes that if you can’t find mom she is probably in front of the grocery store handing out stroke prevention information,” said Paletz “I am extremely committed to educating the public about stroke prevention and stroke awareness, should the need arise, to make sure people understand to seek treatment quickly to call 911.” she said. “Not only to inform people what to do to prevent stroke and what lifestyle changes you need to make to prevent stroke, but to reach out to high risk populations and educate children about stroke as well. I will use any opportunity to spread the word.”

Read More : Parts 1 & 2, Parts 3 & 4

Find out more about National Stroke Association’s Stroke Center Network (SCN) program!

Questions about SCN can be directed to pmembers@stroke.org or 303.754.0935.

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