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ENCSN Stroke Resources
Stroke Continuing Education Resources
Advanced Stroke Life Support Courses (ASLS)
From March 2009-October 2009, ENCSN helped organize, sponsor, and/or publicize 15 ASLS classes which trained 334 health providers in ASLS in Eastern NC. What is Needed to Host an ASLS Class ENCSN helps organize and sponsor ASLS classes at institutions that request a class, be it at a hospital or community college (targeting EMS). In a typical fiscal year (June-June), ENCSN has funds to provide the materials, instructor fee, and EAHEC CE credit fee for four classes in Eastern NC. If ENCSN is the key sponsor of the class, the Network usually requires at least 15 people to attend the class. The costs for the class include the books (~$30), MENDS cards, instructor travel costs, and the instructor fee. ENCSN pays its ASLS instructors $300 to teach a one-day course. The class materials required for the class are a laptop, a projector, a screen, and audio speakers. The laptop needs to be able to play a CD-ROM and have video-showing capabilities. Pre/post tests and evaluations need to be printed for the class as well. Additional costs may be incurred if the class organizers would like CE credits to be offered for the class. At a minimum, ENCSN can help with finding an ASLS instructor and usually can provide ASLS books and the curriculum CD-ROM. For the cost of ordering materials directly from the creators of the ASLS course, go to the University of Miami website, http://www.asls.net/introduction.html. How to Become an ASLS Instructor To become an 'official' National ASLS instructor, a health provider would need to take a class organized by the creators of the ASLS curriculum, University of Miami, or attend a class taught by an instructor trainined through the University of Miami. Since traveling to Miami is cost prohibitive and ENCSN has the goal to spread the knowledge/training of the course, the instructors ENCSN helps train can only teach within NC. With that being said, ENCSN considers a person an ASLS instructor if 1) they've taken an ASLS course, and 2) they've practiced co-teaching an ASLS class with an experienced instructor. In select cases, if a person is certified to teach other courses (ie. ACLS) or instructs classes as a part of their job, ENCSN may find exceptions to the second step. Upcoming ASLS Classes!
February 16th, 2010;
May 10th, 2010;
October 20th, 2010;
December 8th, 2010
All four classes will be held at the Wilson Medical Center Auditorium in Wilson, NC (8:30 a.m. – 5:00 p.m.). 7.5 Nurse Contact Hours provided by Wilson Medical Center CME Credit is pending via Eastern NC Stroke Network and affiliates. WMC employees, register via WilLearn. Non-WMC staff, 399-8481 or sarah.joyner@wilmed.org. There is no cost for the course. Past Classes
Online/Web-based Education
Free, one-hour eLearning Modules through Charlotte AHEC
Preventive Cardiovascular Nurses Association (PCNA) Links to online CE programs as well as dates for live conferences. Saint Francis Care Mediasite recordings of CME lectures on stroke and various related topics. The Internet Stroke Center Presentations by physicians and researchers at Washington University School of Medicine and links to medical references (PubMed) National Stroke Association National Stroke Association site has discipline specific educational modules, including Stroke Nurse Education Modules, EMS/Prehospital Providers, and Medical Providers. NC Stroke Association Tri-State Stroke Network AHEC Connect American Stroke Association American Stroke Association site has access to NIH Stroke Scale training and Get with the Guidelines links. American Heart Association Professional Education Center American Heart Association’s Professional Education Center provides links to conferences, workshops and symposia; on-line courses and podcasts, as well as webinars, webcasts, and CD/DVD selections National Institute of Neurological Disorders and Stroke (NINDS) National Institute of Neurological Disorders and Stroke (NINDS) offers educational materials such as DVD training tools and pocket-sized laminated reference booklets. Give Me 5 For Stroke: Education Resources Provides links to professional resources, fact sheets, patient education materials, stroke statistics, and clinical guidelines and policies. |
| Available | Brain Stroke First Aid Kits | ![]() | Signs of a stroke and "call 9-11" are listed on the outside. Contain bandaids and ointment. Size: 2 inches by 3 inches. |
Available | Stroke Signs/Heart Attack Signs Sticky Card | ![]() | Know The Signs Of Heart Attack And Stroke; A Tips That Stick Info-Card. During a heart attack or stroke, every minute counts. This self-adhesive info-card describes the symptoms of both conditions in easy-to-understand bulleted text, and provides clear directions for how to get help. Info-card can be easily affixed -- and reapplied -- to a bedroom wall, a refrigerator, or any other home surface, making information easy to find, easy to read, and easy to act on. Made of durable card stock, with pre-slit folds and a tab for flat display when open or closed. 8" x 13" (unfolded), 8" x 5 1/2" (folded). **Available in Spanish and English |
Available | Blood Pressure/Stroke Storybook Comic | ![]() | A timely resource for increasing awareness within the Hispanic/Latino community about the seriousness of hypertension and the importance of getting regular blood-pressure checkups. These messages are delivered via a story about a mother and son -- one with high blood pressure and the other with prehypertension -- who make healthy choices after learning that a family member has had a stroke. Audience-targeted language, design, and photographs help make the message more relevant for Hispanic/Latino readers. 8 pages, 5 1/2" x 8". **Available in Spanish and English |
Available | ENCSN Stroke Pens | ![]() | ENCSN Stroke Pens in blue and white which show the ENCSN website link (www.encsn.org) along with the stroke signs and symptoms in two display windows on the sides of the pen. Different symptoms display each time you click the pen back. Pen distribution preference will be given to ENCSN-sponsored training events. |
Available | ID Badge Clips | ![]() | Blue ENCSN ID badge clips which are perfect for health providers working in stroke prevention. Plastic snap loop attaches to badge, and metal clip on back slides over pockets or belt loops. |
| Available | Better Health Prescription Pads | ![]() | Using the medical Rx model, this prescription pad urges patients to maintain healthy behavior: to walk, eat healthier, or a fill-in-the-blank space for other healthy activity (ie. quit smoking). Service providers can check diabetes, high blood pressure, weight issues, high cholesterol, or previous heart problems as the health conditions this healthy behavior "prescription" can improve. Size: 5 inches by 4.5 inches. |
| Available | "Start With Your Heart" Blood Pressure Brochures | ![]() | "Start With Your Heart" Blood Pressure Brochures. Cover reads, "Need help translating & understanding your blood pressure numbers? Here's what you need to know to fight heart disease and stroke." Size: 3.5 inches by 8.5 inches, folded. |
| Available | "Give Me 5" Stroke Posters | ![]() | "Give Me 5" for Stroke posters list 5 signs of a stroke (walk, talk, reach, see, feel) and tell people to "call 911" if they have one of these symptoms. Posters and bookmarks were created by the American Academy of Neurology, American College of Emergency Physicians, and American Heart Association/American Stroke Association. Size (posters): 11 inches by 16 inches. |
| Available | "Faces of Stroke" DVDs | ![]() | "Faces fo Stroke" is a video that runs for 14 minutes and 30 seconds. It features the stroke care team at Carolinas Medical Center NorthEast in Charlotte, NC. This DVD shows the stroke continuum of care, and could be used as a model for other regional hospitals in developing media for their own stroke care programs. This DVD could also be used in community prevention education, since it shows stroke warning signs and features the story of a stroke survivor. This DVD was produced by the Cabarrus County Stroke Collaborative. |
| Available | "Start With Your Heart" Media Advertisement DVDs | ![]() | These "Start With Your Heart" DVDs show four (1-minute) advertisements which focus on stroke and heart attack prevention: "Game Show" Stroke Signs (2 clips); "Lost in Translation" Medical Jargon OR "Paramedic Mindreader" Heart Attack Signs; and "Barflies" Heart Attacks & Secondhand Smoke. Copies of these DVDs can be provided to Network members who will show the health media advertisements in their work setting or community: hospital waiting rooms, county public access channels, community health fairs, etc. IMPORTANT: Please notify Elynor Wilson (elwilson@pittcountync.gov) or India Foy (India.Foy@ncmail.net) once these ads have been shown in your community or workplace, in order to track ad exposure in Eastern NC. This tracking ensures continued funding for this mass media project. |
| Available | JNC7 Blood Pressure Guideline Reference Cards | ![]() | JNC7 Blood Pressure Guideline Reference Cards are available to Worksite Nurses or other health care providers, in conjunction with presentations by Elynor Wilson & India Foy. If your worksite or organization would like a presentation on updated blood pressure and cholesterol guidelines (funds available for limited refreshments), please contact Elynor Wilson (elwilson@pittcountync.gov) or India Foy (India.Foy@ncmail.net) to make arrangements. |
| Available | ATP3 Cholesterol Guideline Reference Cards | ![]() | ATP3 Cholesterol Guideline Reference Cards are available to Worksite Nurses or other health care providers, in conjunction with presentations by Elynor Wilson & India Foy. If your worksite or organization would like a presentation on updated blood pressure and cholesterol guidelines (funds available for limited refreshments), please contact Elynor Wilson (elwilson@pittcountync.gov) or India Foy (India.Foy@ncmail.net) to make arrangements. |
Iredell Memorial Hospital
Wilson Medical Center
Expanding the Window for Administration of tPA in Ischemic Stroke. Pharmacists Letter/Prescriber's Letter. July 2009~Volume 25~Number 250717.
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.
UPDATE: National Reporting of Stroke Measures
(provided by NCSCC Staff, June 2009)
Purpose
The purpose of this update is to inform NC Stroke Care Collaborative (NCSCC) hospitals’ stroke staff [and ENCSN QI workgroup members] of the current issues around national reporting of stroke measures. NC Department of Public Health (DPH) is not the authority on these issues. Our goal is to notify you of the developments of which we are aware. We encourage you to discuss these topics with your Quality Improvement/Performance Improvement Departments. The information below summarizes recent actions by The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) related to stroke performance measures.
BackgroundIn 2008, the National Quality Forum (NQF) endorsed 8 of the 10 stroke consensus measures listed below. The dysphagia screening and smoking cessation measures were not endorsed.
Measure ID # Measure Short Name
STK-1 Venous Thromboembolism (VTE) Prophylaxis
STK-2 Discharged on Antithrombotic Therapy
STK-3 Anticoagulation Therapy for Atrial Fibrillation/Flutter
STK-4 Thrombolytic Therapy
STK-5 Antithrombotic Therapy By End of Hospital Day 2
STK-6 Discharged on Statin Medication
STK-8 Stroke Education
STK-10 Assessed for Rehabilitation
TJC
Effective Oct. 1, 2009, TJC will include the 8 NQF-endorsed stroke measures as a new measure set for core measure reporting for accredited hospitals. For more information about issues related to TJC, go to these sites:
TJC Performance Measurement
http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/
Specifications Manual, starting October 1, 2009
http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Future+NHQM+Manuals.htm
TJC Stroke Core Measures
http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/STK+Core+Measures.htm
Outcome Science is developing the capability for stroke measure submission directly to TJC from the Patient Management Tool for an annual fee of $2,887. Joint Commission PSC hospitals will not be charged the fee. All GWTG-Stroke hospitals were contacted via email. For details, contact Outcome at (888) 526-6700. We encourage you to discuss this with your Quality Improvement/Performance Improvement departments or those responsible for TJC core measures at your institution.
CMSCMS publishes the Inpatient Prospective Payment System (IPPS) annually which outlines the reportable performance measures that impact hospital reimbursement rates for Medicare patients under the National Hospital Inpatient Quality Measures. On April 30, 2009, the FY2010 IPPS proposed rule was published. The document is available online at:
http://www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&o=09000064809ac032The IPPS includes a “structural measure” proposing to require hospitals to report whether or not they are participating in a stroke registry, and if so, the name of the registry. This would go into effect October 2009. The IPPS rule proposed that the 8 NQF-endorsed stroke measures NOT be collected until October 2010. CMS is considering submission of the data via existing registries (e.g.: the NCSCC or GWTG-Stroke) as well as submission via electronic medical records.
Action Requested
We are in the middle of a 60-day comment period for the proposed rule. Comments are due June 30, 2009. Hospital staff is encouraged to offer comments.
Comments can be submitted electronically to the CMS website:
http://www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&o=0900006480971cd2
Click on the comment icon for Document ID CMS-2009-0034-0003
Suggested Talking Points*
These are suggested talking points. We encourage you to use these as a guide but to comment using your own language.1. Indicate support of the inclusion of the 8 NQF-endorsed stroke quality indicators in the FY2010 RHQDAPU initiative. 2. Explain your participation in the NCSCC and your support for data collection to be done via existing registries to reduce the burden for hospitals. 3. Indicate your support for the dysphagia and smoking cessation measures to be included in the stroke set. 4. Explain how focusing on stroke measures has improved the quality of care provided at your institution.
*These talking points are only the opinions of the state program managers for the Centers for Disease Control and Prevention (CDC) Paul Coverdell National Acute Stroke Registry and do NOT reflect any official position of the CDC, the American Heart Association, or the NC DPH.
For more information, please contact the Quality Improvement/Performance Improvement Department at your institution.
The Joint Commission 10 Harmonized Stroke Measures
Facilities that are Primary Stroke Center (PSC) Certified and/or those considering PSC Certification should strive for > 80% compliance with these 10.
- Download Stroke Best Practice Measures Document, February 2009
8 NQS/CMS Measures
The 8 measures that National Quality Forum (NQF) recommended and that Centers for Medicare & Medicaid Services (CMS) has adopted effective 10/01/09 for Stroke. Chart information gathered from the NQF website (with thanks to Ron Cromartie from AHA).
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Stroke Quality Improvement Endorsed by the NC Stroke Advisory Council
Justus-Warren Heart Disease and Stroke Prevention Legislative Task Force
RECOMMENDATION #3
The Council recommends expanded use of recognized stroke registries to monitor and improve the quality of acute stroke care in NC. Performance improvement stroke tools must be designed to:
- Improve the quality of stroke care
- Facilitate secondary prevention
- Enhance communication between emergency responders, hospitals, providers and other key stroke stakeholders
(11;"Prelimary Findings and Recommendations of a NC System of Stroke Care," 2007)
NOTE: This recommendation was used to successfully request NC legislative funding in 2007.Download full 2007 Stroke Advisory Report, "Preliminary Findings and Recommendations for a NC System of Stroke Care."
NC Map of Stroke QI Programs
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NC Stroke Care Collaborative/NC Stroke Registry (NCSCC)
Contact: Carol Murphy
cmurphy@unc.edu
(919) 843-2396
Download NCSCC brochure here
Download NCSCC February 2009 Newsletter here
Paul Coverdell National Acute Stroke Registry For Quality Improvement. The goals of the North Carolina Stroke Care Collaborative are to: Evaluate the current state of stroke care in North Carolina; Facilitate quality of stroke care improvements in NC hospitals; Build a foundation for a state-wide stroke registry.
More Information about NCSCC
- Paul Coverdell National Acute Stroke Registry Surveillance --- Four States, 2005--2007, MMWR Surveillance Summaries, November 6, 2009 / 58(SS07);1-23.
Get with the Guidelines-Stroke (GWTG-Stroke)
Contact: Ron Cromartie, FAHA Senior Consultant, Quality Improvement
American Heart Association
Mid-Atlantic Affiliate
Quality Improvement Initiatives
Get With The Guidelines
3131 RDU Center Drive, Suite 100
Morrisville, NC 27560
(919) 463-8332 (direct)
(919) 463-8292 (fax)
(919) 491-6595 (mobile)
Ron.cromartie@heart.org
Download GWTG brochure here
GWTG Stroke Fact Sheet Get With The Guidelines-Stroke (GWTG-Stroke) helps ensure continuous quality improvement of acute stroke treatment and ischemic stroke prevention. It focuses on care team protocols to ensure that patients are treated and discharged appropriately. The program is available for implementation at acute care hospitals nationwide.
Presentations from the GWTG-Stroke Meeting
5/13/09 in Durham, NC
- GWTG-Stroke Welcome by Ron Cromartie (AHA/ASA)
- A Unit Based Code Stroke Response Team by Susan Freeman (PCMH)
- Iredell Memorial Hospital by Lynn Teddler Bullard
- Telestroke: a different approach to stroke care by Dr. Robert Adams (MUSC)
- Improving Stroke Care by Following Guidelines by Dr. Reid Taylor (Mission Hospitals)
- GWTG-Stroke: Stroke Performance Dashboard by Gwen Ainsworth (Forsyth Medical Center)
(Resource provided by the ENCSN Steering Committee)
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The Interactive Metronome Study at East Carolina University
Click here to download Interactive Metronome Study Brochure.
Department of Occupational Therapy
www.ecu.edu/otNow recruiting for 20 new study participants!
Title of Study: The Examination of Upper Extremity Movement Smoothness
following Stroke post Intervention with Interactive Metronome®
What is the Interactive Metronome®?
The Interactive Metronome® (IM) combines the concept of a musical metronome with a patented technology program that accurately measures, assesses and improves a person’s rhythm and timing. It is an advanced assessment & treatment program developed to improve the processing abilities that affect motor planning and sequencing, which are central to human activity. This improvement, we hope, is extended in one’s daily activities in self care.
IM addresses:
1. Brain timing
2. Rhythmicity
3. Synchronicity
4. Increasing the speed and coordination of informational signals within the brain
5. Improving the processing abilities that affect attention, motor planning, and sequencing
6. Coordination
What do we hope to learn?
The purpose of this research study is to understand if participating in an occupational therapy intervention which uses IM treatment as a modality, has a positive effect on one’s motor abilities. The information from this study will help therapists better develop effective treatment plans for individuals who have difficulty performing their self care tasks.
What do we need from you?
As a participant in the study, you will complete 2 standard rehabilitation evaluations used to determine how effective you use your arms and hands. These set a baseline for use to see if there are improvements after participating in the research treatment sessions. These evaluations take about 30 minutes and ask you to move your arm and pick up and move simple objects. They will help the researchers measure the amount of movement your have in the arm, fingers, and hand. You will then be asked to participate in six Interactive Metronome® treatment sessions. Upon completing these sessions you will be asked to return to the OT Lab for a repeat of the two evaluations you took to establish your baseline scores.
How Can I Participate?
This study needs volunteers and help. Please contact the Dr. Leonard Trujillo or Annette Jones, OTR/L for information on how to get involved or to participate in the study.
Leonard Trujillo
252-744-6195 phone
252-744-6198 fax
trujillol@ecu.edu
Annette Jones
252-531-7011
jonesanne@ecu.edu