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It starts with the Fab Five: Nurse leadership team leads a 40-member squad of stroke pros

Thursday February 20, 2014
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Stephanie Casal, RN
In October 2012 the Stanford (Calif.) Hospital and Clinics was the first facility in the country to receive comprehensive stroke center designation from The Joint Commission. Since that time, the center continues to excel with its nurse-driven initiatives and interprofessional collaboration, according to Teresa Bell-Stephens, RN, CNRN, nurse coordinator, department of neurosurgery/clinical neurosciences.

“Our center provides the continuum of care, working in collaboration with EMS personnel from the moment patients are identified as possibly having a stroke well into the time they return to the community,” said Stephanie Casal, RN, MS, CNS, stroke coordinator. She is quick to recognize the many departments, like stroke neurology, neurosurgery, interventional radiology, emergency medicine, nursing, pharmacy, laboratory and several other teams for their hard work and collaborative efforts.

On the CSC nurse leadership team, Bell-Stephens and Casal are joined by Mary Marcellus, RN, interventional neuroradiology nurse coordinator; Isa San Pedro, RN, CNRN, neuroscience nurse for stroke neurologists; and Joli Vavao, RN, CNRN, MSN, ACNP, lead APP, neurosurgery.


Teresa Bell-Stephens, RN
What sets them apart

The nurse leadership team works with the stroke interdisciplinary team of more than 40 members, charged with addressing performance improvement issues like ensuring that lab values are reported to the ED more quickly; that patients are transported to CT scans in a more timely fashion; and that patients’ vital signs are checked every 15 minutes after tPA administration during transfer handoffs.
“SIT work always is a collaborative effort and involves improvement in communication and processes,” Bell-Stephens said.

Work groups responsible for the implementation of PI projects discuss progress and obstacles encountered with the SIT, and they work in real-time to find solutions and evaluate practice changes.

The RN team also has led in the development of a CSC electronic medical record with Epic, a well-known software company that assists organizations with electronic health record systems. The first of its kind, the stroke navigator offers more discrete data fields that the nurses plan on using to collect more accurate data and examine patient outcomes. Still in the staff training phase, they hope it will serve as a model for other stroke centers to use, Vavao said.


Isa San Pedro, RN
These five nurses cover all bases, from developing policies and procedures for evidence-based care to implementing the stroke interventional radiology process, a rapid transfer policy developed by a group of RNs, MDs and administrators.
“As soon as a patient is identified as possibly benefitting from a cath lab procedure for stroke treatment, the patient is accepted and transport, usually by helicopter, is dispatched,” Marcellus said. “We have been able to significantly decrease the transport time for these acute patients with the SIR process.”

On the other end, San Pedro cares for patients in the stroke clinic after hospitalization and refers them to the neuroscience clinic if they are experiencing complications like seizures, migraines or pain. She also makes phone calls to patients diagnosed with a stroke, within seven days after hospital discharge to follow up on patient needs, whether related to appointments, home care services or education.


Joli Vavao, RN
Nurse-driven success

What’s striking to Vavao, who coordinates the care of stroke patients in the inpatient and outpatient settings, is the administrative support the RN team has received. “It’s a culture we work in, where we identify the changes we need to make and we are supported with the staff, resources and tools to make them happen,” Vavao said. “We have changed the way we do things, and we make a difference in patient care.”


Mary Marcellus, RN
Case in point: Two years before The Joint Commission designation, Alison Kerr, RN, MSN, executive director, neuroscience service line/psychiatry and behavioral sciences, empowered the five CSC nurses who then motivated the larger interprofessional teams to change structures and processes, which brought them where they are today, Bell-Stephens said.

“We’ve learned the best from one another and from our interprofessional collaboration, and our passion for what we do is what drives us to make a difference in patient care,” Bell-Stephens said.

To see what else is trending in stroke, visit www.Nurse.com/Stroke.


Janice Petrella Lynch, RN, MSN, is nurse editor/nurse executive. Post a comment below or email specialty@Nurse.com.