Meticulous monitoring to save lives

UF Health Jacksonville nurses follow extensive guidelines when stroke patients receive tPA.

When someone has a stroke, seconds count. Immediate treatment can minimize the long-term effects and even prevent death.

A stroke occurs when a blood vessel in the brain is blocked by a clot or ruptures, preventing the flow of oxygen. The longer you go without oxygen, the greater your chance of brain damage. With each minute that passes, a stroke patient loses approximately 2 million brain cells. After about 10 minutes, the damage can be severe.

Most strokes in the United States are ischemic, or caused by blood clots. Tissue plasminogen activator, or tPA, is a clot-dissolving medication used to treat ischemic strokes. It must be administered to most patients within three to four-and-a-half hours of the onset of symptoms, but that is not the only time constraint involved with the use of this medication.

“A side effect of receiving tPA can be bleeding from the body or the brain,” said Vicki Coppen, stroke program coordinator at UF Health Jacksonville. “It does not happen often, but can be devastating when it does. So, it is imperative for the nurses to do frequent vital sign and neurological checks to catch any side effects early.”

According to The Joint Commission guidelines, patients who receive tPA are required to have their vital signs checked and a neurological assessment performed at specific intervals: every 15 minutes for two hours, every 30 minutes for six hours and hourly for 16 hours.

“You can imagine how difficult this is on a typical day, let alone when the departments are exceptionally busy,” Coppen said. “If a patient experiences a severe side effect, such as bleeding in the brain, early recognition can not only save their life, but also save the quality of their life.”

UF Health Neurology – Jacksonville recognizes nurses who complete 100 percent of the required vital signs and neurological assessments with a certificate of appreciation. In the two years recognitions have been given, more than 200 nurses from the Emergency Department, interventional radiology, medical intensive care unit and neuro intensive care unit have been awarded at least once — with some as many as seven times. Since the inception of the program, the compliance rate has increased from 30 to 70 percent.

“The nurses who take care of these patients are highly trained in the recognition of neurological changes through their assessments,” Coppen said. “By completing and documenting them, they satisfy The Joint Commission requirements, but most importantly, give patients the best care possible.”

Nurses Who Have Been Recognized Five or More Times

Debra Belus, Adrienne Blum, Margaret Brennesholtz, Paul Carswell, Christopher Chambliss, Rebecca Chiaverini, Kalee Davis, Lisa Downey, Richard Florendo, Gertha Isma, Lynn Iturra, Jason Jacobson, Karen Kreger, Grady McNabb, Sarah Pane, Christian Shotwell, Yolanda Susanne, Audra Sypniewski, Umerah Uzonwa, Elizabeth Wiard, Roslyn Winters and Brittany Yonker