Registered nurses and other staff at Lompoc Valley Medical Center in Lompoc, Calif., are learning a new way to treat stroke patients for the facility's recent Santa Barbara County Emergency Medical Services designation as an Acute Stroke-Ready Hospital.
A "Code Stroke" overhead page is now called at the 60-bed hospital when a patient walks into the ED with stroke-like symptoms, or a patient on the med-surg unit begins showing signs of stroke, or EMS reports an incoming "Positive Cincinnati Stroke Scale" patient.
When a Code Stroke is called, clinicians now work alongside a Remote Presence Virtual Independent Telemedicine Assistant (RP-VITA) robot.
A High-Tech Staff Member
Nicknamed "Dr. Robot," the RP-VITA's "head" is a computer monitor and the "body" is housing for electrical connections and software. The 5-foot-tall machine glides with autonomous navigation technology.
In a Code Stroke, the robot goes to the treatment room and a neurologist with Santa Barbara Cottage Hospital's Teleneurology Network appears remotely on the computer screen. The neurologist, with Dr. Robot as the conduit, initiates a two-way conversation with the patient and staff.
The hospital's Code Stroke Response Team aims to get every suspected stroke patient to the imaging department for a computed tomography scan and have it interpreted by a physician in less than 45 minutes.
"It's a hospital-wide effort," explains assistant nurse executive Yvette Cope, MSN, program coordinator for Code Stroke. "The ED is so busy, and a stroke patient is one-to-one. We need ancillary staff to do this."
Lorraine Jones, MSN, ED director, says the EMS pre-notification from the field to the nursing staff is critical to meeting best practice goals.
"Once we know a stroke is coming in, we gear up," Jones says. "We've notified the neurologists. It's all hands on deck before the patient arrives."
ED nurses are involved in every part of the Code Stroke call. Nurses initiate NIH stroke scale scoring; they perform patient assessment with the neurologist on screen; and they set up the IV for possible administration of tissue plasminogen activator. "Before the neurologist signs off from the robot, he or she always asks the nurse, 'Is there anything else I should know?'" Jones explains. "It's great to have that interaction between nurse and neurologist, through that screen."
A Change in Treatment
The Lompoc Valley community (only 45,000 residents) does not have a full-time neurologist. Before Dr. Robot arrived, patients believed to be having a stroke were usually transferred out of town to a larger hospital. Now, the hospital's telemedicine agreement with Santa Barbara Cottage Hospital allows more patients to remain at the hospital and in their own community for recovery.
Currently, all 28 ED nurses are certified in stroke care by NIH criteria, as are all 15 critical-care unit nurses and 5 charge nurses. The 50 nurses in med-surg are pursuing certification.
Jones said her nurses are energized by Dr. Robot's arrival. "When they see a code that flows effortlessly, where the staff are like a symphony and do everything they way they're supposed to do it, they want to be a part of that. Nurses love working with critical patients. When improvement happens right before your eyes, it's almost miraculous." n
Nora K. Wallace is the public relations coordinator for Lompoc Valley Medical Center in Lompoc, Calif.
Photo Caption: Staff at Lompoc Valley Medical Center use "Dr. Robot" to virtually consult with a neurologist.