|Georgie Knaub, Neuro Unit's nurse educator, offers education to stroke patient Julie Powell.
|Barbara Oaks, above, was delighted to be back in her garden on June 14. She experienced a stroke in 2009 and has received ongoing therapy since then. She knew the signs of stroke and notified her husband, Wendall (background), and was quickly able to reach the hospital for treatment.
|To demonstrate urgency, an hourglass is often used as the symbol for stroke treatment. A stroke patient loses about 2 million brain cells each minute.
|Dr. Gerald McIntosh is a neurologist and medical director of the PVH stroke program.
Julie Powell's 15-year-old daughter recognized the signs: Her mom was having a stroke.
"She asked her mom to smile and she saw the droop," recalled Georgie Knaub, educator for stroke patients at Poudre Valley Hospital.
This scenario is every neuro clinician's hope: a patient arriving early at the hospital because she or a family member knew the signs of stroke.
That was the case June 11 when the mom, Julie Powell, was admitted to PVH's neuro med/surge unit after having a transient ischemic attack.
Unfortunately, strokes have become more common as obesity rates, stress and other risk factors increase across the nation.
"More people are at risk for stroke than any time in the past," said Kathi Patterson, advanced practice registered nurse. "We have to be ready to respond to that increased risk, and we are."
[Related: PVH receives re-certification as Advanced Primary Stroke Center on Oct. 9, 2012, and UCH stroke program earns third joint commission certification]
Put in place five years ago, the stroke alert program has saved lives and preserved functioning of stroke victims in northern Colorado. The program operations at PVH and MCR, and valuable working relationships will become cemented with the University of Colorado Hospital in the future.
Knaub said the stroke program has changed the way work is done at the two northern Colorado hospitals. Before the program, the clinical staff mainly offered supportive care for patients for a variety of reasons that ranged from new medications to patients arriving earlier because of awareness of stroke symptoms.
"Now," Knaub pointed out, "there are interventional tactics we can do to lessen the impact of stroke. It's a great feeling to wake up in the morning and know we can make a difference. When all the steps in the stroke alert system fall into place, we can significantly improve patient outcomes. It's inspiring to watch stroke patients walk out of here and go back to doing what they love to do."
Better, faster stroke response
Stroke alert processes at PVH and MCR continue to get faster and more streamlined. With stroke, the clock starts ticking immediately. To demonstrate the urgency, an hourglass is often used as the symbol for the need to be aware of time. The artwork shows brain squeezed into the top of the hour glass and pieces of the brain are falling like grains of sand down into bottom of the glass.
"A stroke patient loses about 2 million brain cells each minute, so every minute counts," Knaub said. A brain has about 100 billion cells.
Stroke alert times continue to improve. The current record is 54 minutes from the time patients enter the hospital to the time they get a CT scan to identify the stroke and receive the clot-busting drug tPA. The national goal is 60 minutes.
"Our CT/radiology staff members are keenly aware of getting the patient to CT and therapy as fast as possible," Patterson said. "When a stroke alert is sent from emergency medical services, staff members immediately clear the scanner. Radiologists are on hand to read CTs within six minutes. The ER gets patients through quickly and our physicians are fast at doing consultations."
The streamlined processes have earned the stroke program at PVH national recognition. In 2010, the PVH stroke program was certified as an Advanced Primary Stroke Center by The Joint Commission . The American Stroke Association has awarded the stroke program with a bronze (2008), silver (2010) and gold (2012) awards for meeting evidence-based stroke indicators 85 percent or more of the time.
Helping the community Act FAST
Much of the program's success has depended on community members recognizing the signs of stroke quickly, then calling 911 and getting to the hospital fast.
"The community is more educated about stroke today than in the past," Knaub said. "Some of that's due to our community education programs -- namely our annual Spotlight on Stroke, the Rockies' Strike Out Stroke program, our participation in 9Health Fairs, and our patient education efforts."
The message for the public is to think FAST when it comes to stroke. FAST stands for
- a drooping Face;
- drifting Arms;
- slurred Speech)d and
- acting fast (Time).
When tPA is given within three hours of the onset of symptoms, disability can be reduced.
"I've seen patients slurring their words and after a few minutes of getting tPA they are sitting up and talking normally," Knaub said. "It's amazing,"
PVH's stroke program achieved a 100-percent patient education rate in the first quarter of 2012. That means each stroke patient was educated on five items: personal risk factors, signs and symptoms of stroke, calling 911 quickly, follow-up care, and medications.
"Other hospitals across the nation run at about 88 percent compared to our 100 percent," Patterson said. "That's a victory.
A patient's story
The challenges that some stroke patients face sometimes seem insurmountable to them and their family members. It takes a lot of hope, faith and dedication to move ahead. The story of one stroke patient and her husband is an excellent example of what some patients may face.
On a Sunday afternoon in May 2009, Barbara Oaks, a 66-year-old Fort Collins resident, started feeling strange.
"The light hurt my eyes and I had pain in my lower neck and a terrible headache," she recalled recently.
She called her husband, Wendall, and said she thought she was having a stroke. Working as a nurse all of her adult life, she knew the symptoms. She was a triage nurse for years at the Women's Clinic.
Luckily, her husband was home instead of traveling for his job as the U.S. Department of Agriculture's chief information officer. He moved swiftly. "I immediately called 911 and within about 10 minutes the ambulance was at the house and transported us to PVH. PVH had things up and ready and we received a CT scan almost instantly."
That's when the long journey began. Oaks spent weeks in the ICU and neuro unit recovering from her severe hemorrhagic stroke, months in LifeSkills Rehab, and ongoing outpatient multi-day therapy.
Two years later she still receives visual and physical therapy to relieve persistent dizziness that makes it hard to walk. She has weakness and Parkinson-like shaking in her right side. Her speech is slow, but usually clear. She can walk, but is shaky.
"Still, each week we see improvement," her husband said. "Last summer she couldn't dig in the garden or plant a pot. This year she is nearly back to her old gardening self."
Despite her challenges, Oaks stays positive. This fiercely independent native of Ontario still has dreams of hiking tall mountains when she's 80. She spent some of her young married life living off the grid in Idaho where she grew her own food and raised her children. It's this spunk and personal fortitude that helped her not only survive the stroke, but grow and gain wisdom from it, rather than letting it bring her down, she said.
"I used to ask, ‘Why me?' I was healthy, had low blood pressure and none of the risk factors," Oaks said. "But at some point you have to accept that it happened and not try to figure out why. Today, I am better at accepting the stroke and no longer compare myself to whom I was before."
Barbara and Wendall Oaks admit that it takes a lot of energy to stay positive, but it is much better than the alternative.
"We were close before, but the stroke has made us even closer. We've learned a lot about trust and patience," Wendall Oaks said.
They speak regularly in public about their stroke experience, including at a recent PVH-sponsored Spotlight on Stroke community forum. Oaks said she also finds great help in the stroke support group at the Center for Rehabilitation Services in Fort Collins. She receives therapy and is a peer mentor for other persons recovering from stroke.
Gaining Strength with UCH
With the creation of University of Colorado Health, there are even more opportunities to improve stroke care, said Dr. Gerald McIntosh, neurologist and medical director of the PVH stroke program.
"We are currently meeting with the University of Colorado Hospital to make sure our stroke programs are consistent with each other," Dr. McIntosh said. "By working together we'll increase benefits to the community and continue to have timely interventions and stroke protocols that meet or exceed national standards."
"We now have the ability to transfer people to or from other University of Colorado Health hospitals in a timely manner so they can get needed surgical interventions to treat stroke. It's a new option for us to tap into," Patterson added.
This might be an option for hemorrhagic stroke patients. That type of stroke is the result of ruptured and bleeding vessels, verses clots, and can be helped by surgery.
"It's a goal to strengthen our integration with other facilities and take advantage of their advanced technologies in a hyper-rapid response manner," Patterson said.
PVH and MCR have worked to increase referrals from outlying hospitals, a move that will expand the system's geographical reach and provide better stroke response to people in more communities.
"We are working with hospitals in Laramie, Cheyenne, Steamboat, Estes Park and several eastern Colorado hospitals," McIntosh said. "With our certified stroke program, we are on par with stroke programs in large urban areas, like Denver, San Francisco and Chicago."
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