Cumbria and Lancashire Telestroke Network. Standard Operating Procedure: Alert for Redirection of FAST-Positive Patients during CT Scanner Failure

Transcription

1 Standard Operating Procedure: Alert for Redirection of FAST-Positive Patients during CT Scanner Failure 1

2 Table of contents Cumbria and Lancashire Telestroke Network Page 1 Objective 1 2 Scope 2 3 Process Contacts 7 5 Escalation 8 6 Review & audit 8 7 Appendices 8 Document Title Draft Date Modified Document Reference Name Title Effective Date Name Title Effective Date Name Title Effective Date Name Title Effective Date Name Title Effective Date Sign off 2

3 1) Objective This procedure describes contingency plans across Cumbria and Lancashire for the hyperacute stroke pathway should a CT scanner fail in any site and existing internal contingency procedures are unable to absorb the impact. The objective is to ensure that suitable candidates for thrombolysis are not prevented from accessing the treatment by equipment failure. 2) Scope This standard operating procedure sets out the procedure for: Alert and cascade systems for all stakeholders should a problem arise with a CT scanner that cannot be resolved internally Redirection of FAST positive patients Alert and cascade systems for all stakeholders for when CT scanners are repaired Trust procedures for clinical governance and maintenance are out of scope of this procedure. Internal Trust procedures for contingency in the case of CT scanner failure are provided as appendices in section 7. Patients are currently admitted across eight geographical sites for thrombolysis treatment. These are: Royal Blackburn Hospital Royal Preston Hospital Blackpool Victoria Hospital Royal Lancaster Infirmary Furness General Hospital West Cumberland Hospital Cumberland Infirmary Southport and Formby District General Hospital 3) Process The below maps describes how the Cumbria and Lancashire Network will aim to maintain hyper-acute service and optimise opportunities for thrombolysing suitable candidates in the event of a CT scanner failing. In each map, swimlanes indicate responsibility for each stage of the procedure - Figure 1 shows the procedure to be initiated in the event of CT scanner failure - Figure 2 shows the procedure to be initiated once the CT scanner is repaired - Figure 3 shows contact lists for external alerts 3

4 Site Royal Blackburn Hospital Royal Preston Hospital Blackpool Victoria Hospital Royal Lancaster Infirmary Furness General Hospital West Cumberland Hospital Cumberland Infirmary Southport and Formby District General Hospital CT failure divert contingency plan Have existing internal contingency procedures to absorb the impact (2 scanners) Have existing internal contingency procedures to absorb the impact (2 scanners). If both scanners fail, patients will be transferred to BVH Have existing internal contingency procedures to absorb the impact (2 scanners) If both scanners fail, patients will be transferred to RPH Patient would be transferred to nearest (in time) thrombolysing hospital which would be RPH Patient would be transferred to nearest (in time) thrombolysing hospital which would be RLI Patient would be transferred to nearest (in time) thrombolysing hospital which would be FGH or CIC dependant on patients location Patient would be transferred to nearest (in time) thrombolysing hospital which would be WCH or Newcastle, dependant on patients location Patient would be transferred to nearest (in time) thrombolysing hospital which would be either RPH or Aintree, dependant on patients location 4

5 RADIOLOGY A&E MANAGERS AND SENIOR RADIOGRAPHER NWAS Figure 1: SOP for CT scanner failure for FAST positive patients Cumbria and Lancashire Telestroke Network CT scanner fails 2 nd scanner available no further action Can the scanner be fixed within 30 Yes Fix internally and report equipment failure through internal reporting procedure 2 nd CT scanner fails No Radiology inform internal stroke team and emergency doctors via bleep/telephone within 30 minutes of scanner failure Record of communication noted Emergency doctors cascade message immediately to all team members Senior Radiographer informs on-call Business/Site Manager who initiates divert policy Business/Site Manager to contact nearest site to ask for Exec permission to divert to that site. Permission granted inform: Record of communication noted Business/Site Manager to contact NWAS by fax to initiate divert within 20 minutes of receiving notification NWAS Fax No: On receiving fax, the Ambulance Control cascades message immediately to all crews Redirection commences 5

6 RADIOLOGY A&E MANAGERS NWAS Cumbria and Lancashire Telestroke Network Figure 2: SOP for CT scanner repair CT scanner repaired Radiology inform internal stroke team and emergency doctors via bleep/telephone immediately Record of communication noted Emergency doctors cascade message immediately to all team members Radiology inform on-call Business/Site Manager within 20 minutes of receiving notification of fix Business/Site Manager to contact nearest hospital and NWAS to inform them divert off Record of communication noted Ambulance Control cascades message immediately to all crews Normal pathway resumes 6

7 4) Contacts Cumbria and Lancashire Telestroke Network Figure 3: Contact Lists ORGANISATION DEPARTMENT CONTACT 1 CONTACT 2 CONTACT 3 Radiology Emergency doctors Stroke Team Radiology Emergency doctors Stroke Team Radiology Emergency doctors Stroke Team Ambulance Control Name Number Name Number Name Number 7

8 4) Escalation If it becomes apparent that this procedure cannot be fulfilled at any point, an escalation should be made immediately by telephone to: This escalation should be followed up by , and the learning points will be shared across the Network by the Network Support Team. 5) Review and audit This procedure will be reviewed on an ad hoc basis at the Post-Implementation Monitoring meeting in light of any redirections which occur. 6) Appendices Local Trust policies providing contingency for CT scanner failure which can be resolved without escalating to this network policy are detailed below: 8

9 APPENDIX 1 01 April 2010 CI074 Preston Stroke Thrombolysis Pilot Changes to the patient pathway for access to Stroke thrombolysis at Royal Preston Hospital The access to acute stroke care in the early hours after onset of symptoms dramatically improves the outcome for stroke patients (National Stroke Strategy, DoH 2007). Acute stroke care includes, for some patients, access to CT or MRI scanning and thrombolysis, which must be delivered within a short time of symptom onset. Additional specialist assessment and nursing also play a significant part in patient outcome. Lancashire Teaching Hospitals Trust and Central Lancashire PCT have agreed to pilot the implementation of thrombolysis for patients with acute stroke from 0900 hours on 1st April During the six months pilot all patients presenting with a positive FAST and in the Royal Preston Hospital catchment area only will be conveyed to the Emergency Department on a stand-by or courtesy call. Patients presenting with compromised vital signs should continue to be taken directly to ED as normal (see attached flow chart). The original plan was to introduce the stroke thrombolysis pathway/pre-alert after the Easter Bank Holiday, but due to circumstances beyond our control this date had to be brought forward, so please accept my apologies for the short notice. Head of Service Cumbria and Lancashire 9

10 OUT OF HOURS STROKE PATHWAY (Monday Friday hours and all day Saturday and Sunday) F.A.S. Test A positive F.A.S Test should be considered if any one or more of the following are present. Facial Weakness: Ask the patient to smile, showing their teeth. This makes one sided facial weakness apparent. Arm Weakness (motor): Ask the patient to hold both arms outstretched at 90 degrees in front of them with their palms downward, and close their eyes for 5 seconds. The arm with motor weakness will drift downwards. Speech: Ask the patient to repeat a phrase. Assess for slurring or difficulty with the words or sentence. Ensure careful approach Gain history (MOI) & time of onset AVPU Establish ABCD Patient position Administer Oxygen Therapy If SpO2 <95% Ambulance Perspective If any of the following are present then the patient must be transferred to the nearest Emergency Department Airway is it compromised? Cannot be managed by simple manoeuvres Breathing RR <10 or >30 and/or SpO2 is <90% post high concentration oxygen Circulation BP <90mmHg or pulse <40bpm or >120bpm Disability GCS <8 Blood Glucose must be measured and recorded Positive Vital Signs Neurological Assessment (F.A.S.T.) Negative Is the time of symptoms onset within 4 hours? No Transport to nearest ED as per normal procedure Yes Stroke Courtesy Call to XXX ED including time of onset of symptoms Load and go to XXX Blue Light Transport (bring a witness where possible) Consider IV access en-route (site in unaffected arm) Re-assess Vital Signs 10