Site Map / Print this Page

ENCSN Hospitals' Plans of Care Workgroup

Workgroup Goal: "Primary stroke centers and acute stroke capable hospitals establish and consistently use clinical plans of care that are based on national guidelines and standards of care."

Workgroup chairs: Norman Taylor, Norman.Taylor@onslowmemorial.org



Next Meeting
April 14, 2010 (ENCSN Quarterly Meeting)

  • Hospitals' Plans of Care Meeting Minutes, 3/16/10
  • Hospitals' Plans of Care Meeting Minutes, 1/13/10
  • Hospitals' Plans of Care Meeting Minutes, 11/17/09
  • Hospitals' Plans of Care Meeting Minutes, 10/14/09
  • Hosptials' Plans of Care Meeting Minutes, 8/24/09
  • Hospitals' Plans of Care Meeting Minutes, 6/3/09
  • Hospitals' Plans of Care Meeting Minutes, 3/31/09
  • Hospitals' Plans of Care Meeting Minutes, 2/3/09
  • Hospitals' Plans of Care Meeting Minutes, 12/09/08


    • Plan of Care Development Resources

    Regional Genentech (Activase) Contact
    Pat McCormick
    Clinical Specialist
    Genentech USA
    919-802-5214
    mccormick.patricia@gene.com


    Existing Collected Stroke Plans of Care:

    DISCLAIMER: These listed Plans of Care are to be used as guides. These documents were shared with ENCSN before April 2009 and may not represent the most recent national guidelines or most recent protocols at each of these hospitals. A future goal of the HPC workgroup is to create a unified summary Plan of Care, however this project is still in development. We have posted these Plans so that Network members may have a starting point for the creation of their own Plans, and to see the formats of existing NC hospital Plans of Care. The information contained in each Plan of Care does not constitute medical or legal advice. Neither ENCSN nor the authors of the Plans of Care provided make any claim, promise or guarantee about the accuracy, completeness, or adequacy of the information contained therein, or that any Plan is appropriate for your particular use. Neither ENCSN nor any other party involved in the preparation of these Plans shall be liable for any damages, of any kind, resulting in whole or in part, from any user's use of or reliance upon this material. To receive the most up-to-date guidance on stroke protocol development, please participate in the monthly workgroup conference calls and request to be added to the HPC workgroup email list!




    Also see the ENCSN Quality Improvement webpage for resources on Quality Measures!



    Expanding the Window for Administration of tPA in Ischemic Stroke. Pharmacists Letter/Prescriber's Letter. July 2009~Volume 25~Number 250717.



    AHA/ASA science advisory recommends use of tPA between three and 4.5 hours after stroke, from the ECASS III Trial (Stroke. 2009;40:2262.).

    Patients who are eligible for treatment with rtPA within 3 hours of onset of stroke should be treated as recommended in the 2007 guidelines.1 Although a longer time window for treatment with rtPA has been tested formally, delays in evaluation and initiation of therapy should be avoided, because the opportunity for improvement is greater with earlier treatment.

    rtPA should be administered to eligible patients who can be treated in the time period of 3 to 4.5 hours after stroke (Class I Recommendation, Level of Evidence B). The eligibility criteria for treatment in this time period are similar to those for persons treated at earlier time periods, with any one of the following additional exclusion criteria: Patients older than 80 years, those taking oral anticoagulants with an international normalized ratio 1.7, those with a baseline National Institutes of Health Stroke Scale score >25, or those with both a history of stroke and diabetes. Therefore, for the 3-to-4.5–hour window, all patients receiving an oral anticoagulant are excluded regardless of their international normalized ratio. The relative utility of rtPA in this time window compared with other methods of thrombus dissolution or removal has not been established. The efficacy of intravenous treatment with rtPA within 3 to 4.5 hours after stroke in patients with these exclusion criteria is not well established (Class IIb Recommendation, Level of Evidence C) and requires further study.

    Ancillary care for patients receiving rtPA at 3 to 4.5 hours after ischemic stroke should be similar to that included in the 2007 American Heart Association Stroke Council Guidelines.1

    These recommendations, which are based on peer-reviewed publications, should be reevaluated after the results of regulatory agency review of detailed, nonpublicly available data are known. The recommendations use the American Heart Association’s classification of recommendations and levels of evidence shown in the Table.