Hospital Stroke Protocol
Stroke is one of the medical conditions that develop to chronic levels
within the few hours of the onset of initial systems. The use of
appropriate and aggressive medication within a period of three hours
from the onset of symptoms reduces the risk of extensive disability and
damage of the brain (Mercy Medical Center, 2012). However, the
application of such an instant treatment requires health care facilities
to have a pre-determined protocol that can guide health care providers
when attending to patients shortly after they suspect that their client
is suffering from stroke. Although different hospitals have varying
stroke protocols, the standard protocol should address the key aspects
such as identification of stroke symptoms, confirmation of stroke
through the standard procedures (such as CT scan), and administration of
treatment. The hospital stroke protocol is an effective tool that helps
the health care providers in attending and saving the lives and health
of clients who are at the risk of developing medical complications as a
result of stroke.
Implementation of the stroke protocol
The hospital stroke protocol is implemented soon after a patient is
suspected to be suffering from stroke, either within the medical
facility or when the patient is brought into the hospital from the
field. According to Hoegerl, Goldstein & Sartorius (2011) in spite of
the fact that effective treatment for stroke is available, it must be
administered within the first three hours of the onset of stroke
symptoms to avoid mortality and morbidity. The process of implementing
the stroke protocol takes different steps depending on the preference
various health care facilities. However, a standard hospital stroke
protocol developed by Geisinger Medical Center in Pennsylvania is
implemented in six stages.
The first stage involves the arrival of a patient in the emergency
department (brought from the field or other departments of the health
care facility), where stroke symptoms are detected within the first
three hours of arrival (Hoegerl, Goldstein & Sartorius, 2011).
In the second stage, the client is brought back to the examination room
immediately and the stroke protocol started.
The third stage involves the confirmation of the onset of stroke
symptoms by the emergency room staff. The major stroke symptoms detected
include sudden severe headache, trouble walking, and confusion,
numbness, speaking, and trouble of seeing with one or both eyes (Adams,
Once the stroke symptoms are confirmed, the fourth stage is initiated
and involves calling of code stroke and alerting the stroke team. In
addition, other concerned departments (such as laboratory, radiology,
and the nursing staff are alerted in case their services may be needed.
In the fifth, a nurse is assigned to the patient, samples drawn and
critical tests (such as PTT, CT scans, CBC, PT / INR, and chemistries)
conducted by the laboratory department without contrast.
The last stage involves evaluation of the patient by the stroke team
where the decision on whether the tissue plasminogen activator (tPA)
should be initiated is made. The tPA is administered immediately to
patients who qualify while clients who fail to qualify for its
administration are classified as potential candidates for intra-arterial
tissue plasminogen activator (Hoegerl, Goldstein & Sartorius, 2011).
Changes in the stroke protocol
The health care providers have been adopting new approaches to enhance
their effectiveness in addressing the medical condition caused by
stroke. According to Shaw (2005) the health care providers are currently
using additional protocols beyond the tPA with the aim of improving the
patient outcome. Management of the blood pressure is a critical
procedure that health care providers are using to avoid the
deterioration of stroke and normalize the health condition of a stroke
Many health facilities have been creating the acute stroke teams that
are led by professionals in cardiovascular diseases. The teams are
composed of physicians, physician assistant, and a nurse who is
available at all times According to Shaw (2005) members of the acute
care stroke team should be available within a fifteen minute call.
The establishment of written health care protocols for stroke is another
approach that is being adopted by health care professionals in an effort
to enhance efficiency in the treatment of stroke patients. The written
protocols focus on the stabilization of the major functions that are
destabilized by hemorrhage or ischemic stroke through diagnostic
testing, lab services, 24-hour CT scan, and treatment with tPA.
In conclusion, the hospital stroke protocol is an effective tool that
helps the health care providers in attending and saving the lives and
health of clients who are at the risk of developing medical
complications as a result of stroke. Although the hospital stroke
protocol varies from one health care facility to the other, they all aim
at improving the clients’ outcome. The process of implementing the
stroke protocol also varies with health care facilities and it is
implemented within the first three hours of suspecting that the client
is suffering from stroke. The new changes being adopted by health care
providers aim at improving the treatment process and the patient
outcome. The new protocols assist the health care professionals in
addressing the stroke using protocols (such as the creation of the acute
care stroke team, the establishment of written health care protocols,
and the blood pressure management) that are beyond the traditional
Adams, E. (2007). Guide for the early management of adults with ischemic
stroke. Stroke, 38, 1655-1711.
Hoegerl, C., Goldstein, J. & Sartorius, J. (2011). Implementation of a
stroke alert protocol in the emergency department: A pilot study.
Journal of the American Osteopathic Association, 111 (1), 21-27.
Mercy Medical Center (2012). Development of an in-hospital stroke alert
protocol. Iowa: Mercy Medical Center.
Shaw, G. (2005). Hospitals adopt new protocols for stroke care.
Philadelphia PA: American college of physicians. Retrieved January 7,
2014, from HYPERLINK
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