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December 2011
News For You

NCH Introduces TIA Order Set for Observation Patients

Physicians who treat and manage transient ischemic attack (TIA) patients in the Emergency Room or Direct Admit Unit settings at Northwest Community Hospital (NCH) are now using a TIA Order Set for observation patients. The new order set assures prompt assessment of TIA patients and encourages physicians to apply a consistent, evidence-based approach to the triage and evaluation of these patients.

“Recognizing TIA as a harbinger of stroke, our goal is to support physicians in providing comprehensive stroke care, and to expedite the evaluation process of this at-risk population,” says Laura Goldstein, MD, medical director of the Stroke Program at NCH. “With the order set, physicians can identify stroke mechanisms that will guide therapeutic strategies aimed at reducing the patient’s risk of a subsequent stroke.”

The first interaction with TIA patients is to stratify risk of subsequent stroke using the ABCD2 Score. This approach assesses the patient’s risk based on clinical features of the neurological symptoms, duration of symptoms, age, blood pressure at presentation, and history of diabetes. Lower risk TIA patients are expeditiously evaluated in the Medical Observation Unit, while higher risk patients are admitted to the Neurology inpatient unit for evaluation. The Observation TIA Order Set includes:

  • Prompt initiation of anti-thrombotic therapy for all TIA patients
  • Option for urgent MRI imaging of the brain to identify acute tissue injury
  • Evaluation of cardiac rhythm with telemetry for all TIA patients and options for echocardiography to evaluate for a cardiac source of embolus that would warrant consideration of anti-coagulant or direct thrombin inhibitor
  • Laboratory options to evaluate for modifiable stroke risk factors, including hyperlipidemia
  • Options for vascular imaging, including ultrasound, MRA and CTA, to identify extracranial carotid atherosclerosis or vasculopathy amenable to revascularization
  • Patient stroke education by the nursing staff
  • Discharge plan that encompasses stroke risk mitigation strategies

Once patients are transferred to observation or the inpatient setting, nurses conduct frequent neurologic assessments. This allows prompt consideration of acute stroke rescue therapies – such as IV thrombolysis or endovascular intervention – should the patient develop acute stroke symptoms while being observed.

The new TIA Order Set for observation patients is available on the NCH Intranet and will soon be added to CareLink CPOE. For more information, contact Laura Goldstein, MD, at 847.882.6604; Phyllis Cerone, MS, APN, CCRN, director of Critical Care, at 847.618.7530; or Jan Lau, RN, APN, TTS, stroke clinical nurse specialist, at 847.618.2190.

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Last Updated 04/10/2009