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Stroke coordinator champion

Improving practice and elevating care

Featured stroke coordinator1

Debbie A. Estes, RN, BSN Medical City Stroke Program

Debbie A. Estes, RN, BSN

Clinical Program Coordinator, Stroke Program for Medical City Dallas Hospital
daestes2@yahoo.com

Debbie Estes has been a devoted and enthusiastic advocate for stroke care for more than 10 years. She is a passionate and driven stroke coordinator whose leadership efforts have helped 3 hospitals achieve Joint Commission (JC) stroke certification. In addition to her stroke program and protocol development focus, Debbie is devoted to spreading "stroke fever" by leading a variety of stroke education and patient outreach initiatives.

Q&A with Debbie:

What made you decide to focus on stroke, and what do you most enjoy and find fulfilling?

I became interested in stroke in 1996 when AHA added acute stroke to ACLS. As an ACLS instructor I began teaching the stroke algorithm. From there my nursing career seemed to somehow involve stroke. I knew I was hooked on stroke program development when I witnessed my first stroke patient make a complete recovery after receiving optimal care. Stroke program development is an enormous challenge for any healthcare professional and for me building stroke programs is the most rewarding job any nurse could ask for. As stroke coordinators, we are the voice for every patient who enters our door or who has a stroke while in our hospital. I truly love going into a hospital and developing new programs, creating new processes and paving the way for patients to have a chance for complete stroke recovery. In addition, I thoroughly enjoy analyzing the stroke data in pursuit of opportunities to improve processes. Nurses are patient advocates, and I will continue to strive for perfection because, as a nurse, I owe it to my patients.

Describe your current role, responsibilities, and day-to-day activities.

I have had the privilege to lead 3 large urban hospitals through the JC primary stroke certification process, and am now happily a Stroke Coordinator at Medical City Dallas hospital in Dallas, Texas. The responsibilities of a stroke coordinator are many, and on any given day I must wear multiple hats, with no 2 days ever being the same. I am an educator, patient advocate, data abstractor, data analyst, committee chair, committee member, code stroke team member, program planner, marketing agent, public relations representative, secretary, speaker, and overall I must be seen as a member of the team. A typical day for me begins with reviewing medical records for each stroke patient in the hospital with the expectation of improving compliance with the JC's 10 performance measures. From here I go to the stroke units and discuss opportunities with the nursing staff. The largest role I play involves process improvement, which requires interaction with every aspect of the hospital, ranging from environmental services to administration.

Debbie's efforts as Stroke Coordinator at Medical City Dallas hospital helped it to:

  • Achieve primary JC stroke certification
  • Implement standing orders
  • Attain Medical City Dallas' fastest door-to-needle time, which was 22 minutes (NIH recommends door-to-needle times of < 60 min)
  • Establish a stroke network

Which key activities and traits enable a stroke coordinator and stroke program to excel?

My role as a stroke coordinator is tough position. I must motivate each employee to want to get on board and be knowledgeable about stroke and the necessary protocols. A stroke coordinator must be an independent thinker, a great communicator, be passionate about stroke, have strong attention to detail, and be comfortable speaking and educating healthcare professionals, the community, and EMS providers. Patience, perseverance, and persistence are valuable traits for a stroke coordinator. Patience is needed each day when auditing charts. Processes will improve with perseverance, and stroke coordinators must be persistent in all our endeavors. Once, a stroke patient who did not receive optimal care said to me, "Please don't ever stop what you are doing, you are my voice, so please keep trying to educate about stroke." Every time I get discouraged I remember that I am making a difference, I am making changes for my children, grandchildren, and for untold numbers of patients.

We commend you!

Debbie has demonstrated a relentless passion and dedication to spreading the word about stroke. Her drive to continuously improve the quality of stroke treatment, education, and patient outcomes is commendable. Thank you Debbie!

If you would like to congratulate Debbie or ask her a stroke related question, she can be reached at daestes2@yahoo.com

Indication
Activase (Alteplase) is indicated for the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability. Treatment should only be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized tomography (CT) scan or other diagnostic imaging method sensitive for the presence of hemorrhage (see CONTRAINDICATIONS).

Safety Information
Activase therapy in patients with AIS is contraindicated in certain situations (eg, suspicion of subarachnoid hemorrhage on pretreatment evaluation, recent (within 3 months) intracranial or intraspinal surgery, history of intracranial hemorrhage, uncontrolled hypertension at time of treatment, active internal bleeding, known bleeding diathesis (eg, current use of oral anticoagulants, administration of heparin within 48 hours of onset of stroke, platelet count <100,000) (see CONTRAINDICATIONS for full list).

The most common complication during Activase therapy is bleeding. Should serious bleeding in a critical location (intracranial, gastrointestinal, retroperitoneal, pericardial) occur, Activase therapy should be discontinued immediately. Death and permanent disability are not uncommonly reported in patients who have experienced stroke (including intracranial bleeding) and other serious bleeding episodes.

The risks of Activase therapy may be increased and should be weighed against the anticipated benefits in certain conditions. [See WARNINGS in full prescribing information].

  • Patients with severe neurological deficit (eg, NIHSS >22) at presentation. There is an increased risk of intracranial hemorrhage in these patients.
  • Patients with major early infarct signs on a computerized cranial tomography (CT) scan (eg, substantial edema, mass effect, or midline shift).

Treatment of patients with minor neurological deficit or with rapidly improving symptoms is not recommended.

Orolingual angioedema has been observed in postmarketing experience in patients treated with Activase for AIS. Patients should be monitored during and for several hours after infusion for signs of orolingual angioedema.

Please click here for full prescribing information.
References:
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Data on file. Genentech, Inc.