Stroke center certification places HMH in rare company

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Warning signs of stroke listed

By Marty Finley

Staff members at Hardin Memorial Hospital received a belated Christmas present this week.
After a lengthy application process, the hospital was designated a primary stroke center by The Joint Commission after nearly two years of work streamlining the hospital’s stroke protocol and educating nurses and staff on ways to improve care to stroke victims.
The designation places HMH in rarefied air as it becomes one of only 15 hospitals in Kentucky to earn the recognition, said Sheila Smallwood, co-chairwoman of the Stroke Task Force at HMH. Smallwood said more hospitals in the state are in the process of earning the certification and a collaborative effort has emerged among health care providers to improve stroke care in Kentucky.
The Joint Commission awards the certification based on eight measures that primarily examine the level of patient assessment for rehabilitation, the amount of education provided to patients on stroke and stroke prevention and proper usage of pharmaceuticals and therapy based on patient needs.
Stroke is the third leading cause of death in the United States and the leading cause of adult disability, according to the American Stroke Association. Just as troubling, Smallwood added, Kentucky ranks 11th in stroke deaths annually.
The bleak statistics led HMH to launch the task force in 2009 to identify more calculated methods to target stroke intervention through early detection. In tandem, the hospital worked closely with Hardin County Emergency Management Services to sound alerts to HMH as soon as paramedics determine a stroke has occurred.
Ira Dyer, director of Hardin County EMS, said the certification announced Monday is a victory for the county because it provides a local stroke center for patients and improves the response time of both EMS and HMH.
Hardin County EMS primarily follows state medical protocols, which places priority on a stroke patient being transferred to a primary stroke center because the level of care has been proven superior, Dyer said.
In the past, EMS faced a “quandary” because the patient had a small window of time to receive optimal treatment, with a commute to Louisville eating into that timeframe, he said.
At times, Dyer added, finding an open bed at a hospital could be daunting.
“In Louisville, it was like Bethlehem on Christmas Eve,” Dyer said. “There was no room in the inn.”
These factors led Hardin Memorial to start pursuing the certification in early 2010 and begin implementing the latest evidence-based guidelines released by the American Stroke Association, Smallwood said. The hospital will have to seek recertification every two years and maintain the latest research and guidelines.
Additionally, all nurses and staff on every floor of the hospital were thoroughly educated in stroke procedures and guidelines, said Michelle Murphy, director of marketing and public relations for HMH.
When an ambulance arrives at a home and suspects a stroke has occurred, the patient’s motor functions and speech patterns are tested. Dyer said the patient is asked to utter a phrase that takes a significant amount of neurological aptitude to repeat.
Once a stroke alert is sounded, teams at HMH mobilize and prepare for the patient’s arrival, Smallwood said. The goal is to have blood work drawn and results of a CT scan read within 45 minutes of arrival so treatment can begin.
Because most patients wait an hour or two to call 911 after symptoms appear, Smallwood said the hospital acts on a one-hour timeframe.
If a stroke is caused by blood clots, HMH can administer a Tissue Plasminogen Activator to break up the clots and curb the likelihood of permanent disability — a potent treatment if given in time.
“It’s a scary drug, but it’s also a miracle drug,” she said.
Once a patient is admitted to the hospital, physicians and nurses  begin to search for and root out the primary cause of the stroke while identifying any secondary causes as well, Smallwood added.
Sometimes the source is hereditary or natural, but strokes also can be triggered by risk factors such as smoking, obesity or a sedentary lifestyle. Smallwood said the hospital and its staff work hard to educate patients during their stay to reduce these risk factors and modify their behavior for healthier living.
HMH also has increased its level of public education on early detection and urge anyone experiencing stroke symptoms to contact 911 immediately.
“It is an emergency,” Smallwood said.
Dedra Kerr, a registered nurse in the progressive care unit at HMH, said her department has experienced enough stroke cases since the changes were put into place that they act instinctively when a patient arrives.
The designation, she added, hopefully provides some assurance to stroke victims and their families that they will receive the best stroke care available.
“If I was one in the back of that ambulance, I would be comfortable coming here,” she said.
Marty Finley can be reached at (270) 505-1762.


Warning Signs of Stroke

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

Source: The American Stroke Association