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T3 clinical protocols
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Triage
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• All patients presenting with signs and symptoms of suspected stroke should be triaged to Australasia Triage Scale (ATS) categories 1 or 2 (seen within 10 min)
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Treatment
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Thrombolysis (tissue-type plasminogen activator)
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• All patients to be assessed for thrombolysis eligibility
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• All eligible patients to receive thrombolysis
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Fever
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• All patients to have their temperature taken on admission to emergency department (ED) and then at least four hourly whilst they remain in ED
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• Treat temperature 37.5 °C or greater with paracetamol within 1 h
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Sugar
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• Formal venous (laboratory) blood glucose level (BGL) on admission to ED
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• Record finger prick BGL on ED admission and monitor finger prick BGL every 6 h (or greater if elevated)
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• Administer insulin to all patients with BGL > 10 mmol/L (180 mg/dL) within 1 h
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Swallow
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• Patients remain Nil By Mouth until a swallow screen by non-speech pathologist (SP) or swallow assessment by SP performed, i.e.:
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◦ No oral food or fluids to be given prior to swallow screen by non-SP or swallow assessment by SP
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◦ No oral medications administered prior to swallow screen by non-SP or swallow assessment by SP
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• All patients who fail the screen are to be assessed by a SP
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Transfer
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• All patients with stroke to be discharged from ED within 4 h
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• All patients with stroke to be admitted to the hospital’s stroke unit
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T3 Implementation strategy
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Multidisciplinary Workshopsa
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Workshop 1 - Barriers and Enablers Assessment (one at each site, 60 min)
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• To present the details of the trial
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• To identify the local barriers and enablers
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• To identify the local site clinical champion
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Workshop 2 - Action Plan (one at each site, 60 min)
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• To discuss the action plan to address the barriers
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• To ascertain the actions already taken to address the barriers
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• To identify the new local barriers
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Didactic and interactive educationa (minimum one at each site, 30 min)
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• A 20-min PowerPoint presentation and a 10-min discussion
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• An 8-min video developed by an academic ED nurse clinician/opinion leader
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Use of clinical opinion leaders
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• Key national clinical opinion leaders at Workshop 1 and available as needed for any site-requested queries
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• Clinical champions from ED and stroke unit
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• Reminders
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• Reminder poster to display in ED- and pocket-sized card to attach to ID lanyard for staff
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• Proactive direct contact every 6 weeks in the form of the following:
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◦ Site visits every 3 months (face-to-face) using an action plan
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◦ Teleconferences every 3 months with clinical champions and site coordinator using an action plan
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• Emails—reactive and monthly proactive emails
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• Telephone support—reactive
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• Telephone support—reactive and as needed
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