WASHINGTON STATE STROKE NURSING FORUM

American Heart Association/American Stroke Association Get With The Guidelines Pursuit of Clinical Excellence WASHINGTON STATE STROKE NURSING FORUM Thursday, September 18, 2014 9:00AM - 5:00PM Registration begins at 8:30AM The Conference Center at Seattle-Tacoma International Airport International Auditorium 17801 International Boulevard, Seattle, WA

MEET YOUR GET WITH THE GUIDELINES TEAM Rea Anne Arcangel, BSN, MBA Vice President Quality & Systems Improvement (916) 446-6505 ReaAnne.Arcangel@heart.org Elizabeth Peterson, RN, BSN, MPH, CHES Regional Director Quality & Systems Improvement (206) 694-7332 Elizabeth.Peterson@heart.org JoAnne Pineda, MBA Senior Program Director Quality & Systems Improvement (650) 259-6736 JoAnne.Pineda@heart.org For more information on Get With The Guidelines, please visit: www.heart.org/quality

Washington State Stroke Nursing Forum Program Agenda Thursday, September 18, 2014 TIME PRESENTATION TITLE PRESENTER(S) 8:30AM - 9:00AM Registration & Heart Healthy Continental Breakfast 9:00AM - 9:15AM Welcome & Introductions A special thank you to The Chehalis Tribe Elizabeth Peterson, RN, BSN, MPH, CHES American Heart Association/ American Stroke Association 9:15AM -10:00AM Life Simple 7 Presentation Objectives: Describe 2 key factors in Stroke Epidemiology: Stroke is not randomly distributed, We have made great progress in reducing mortality List 2 key factors in What is Ideal Vascular Health? How was Life Simple 7 formulated and what are the options? State 2 items in What is the Implementation Plan? National plan, Hospital plan, Individual plan William H. Likosky, MD, FAAN, FAHA Swedish Medical Center 10:00AM -10:15AM 10:15AM - 10:30AM Survivor Moment How My Stroke Changed My Life.for the Better! Quitting Smoking, Drinking, Getting Fit & Why I Did It Break Wayne Lubin Puget Sound Stroke Ambassador - 2013-2014 10:30AM - 11:45AM INTERACTIVE SESSION & GROUP DISCUSSION - The State of Stroke in Washington: Data Metrics, Best Practices, & Challenges from Emergency Cardiac & Stroke Regions Through Our State Smoking Cessation Counseling Door to CT Times Door to Needle Times Presentation Objectives: Identify 2 evidence based best practice in stroke care and discuss current practice from regions across Washington State. Identify 2 strategies to implement meaningful education and follow up for patients regarding smoking cessation. Matt J. Nelson Washington State Department of Health Kelly Boardley, RN, CEN Cascade Valley Healthcare, North Region Julie Berdis, BSN, CNRN Providence Sacred Heart Medical Center, East Region Valerie Lyttle, RN, MSN, CEN, CNRN MultiCare Good Samaritan Hospital, West Region Moderator: Karen Young, RN, CPHQ Valley Medical Center 11:45AM - 12:30PM Heart Healthy Lunch & Move to Breakout Sessions

Program Agenda Continued TIME PRESENTATION TITLE PRESENTER(S) CONCURRENT BREAKOUT SESSIONS (PLEASE PICK ONE) 12:30PM - 3:45PM New Stroke Nurses: Stroke Nurses Basic Survival Guide Presentation Objectives: State 2 requirements for core stroke team s job descriptions and key competencies Describe 2 stroke competencies. List 2 contributions of inter rater reliability to the accuracy of data collection. Karen C. Kiesz, RN, MN, CNRN, SCRN MultiCare Health System Gena Kreiner, RN, BSN Franciscan Health System Advanced Stroke Nurses: Complex Stroke Complications & Imaging in the First 36 Hours Presentation Objectives: Identify 2 appropriate steps in algorithm for patients with hemorrhagic stroke Identify 3 assessment priorities patients during the first 36 hours after an acute ischemic or hemorrhagic stroke Identify 3 early clinical signs of potential hemorrhagic conversion post ischemic stroke Describe 3 clinical presentations of malignant MCA syndrome Discuss 3 priorities for discharge planning for patients when transitioning levels of care. Christie E. Artuso, Ed.D., RN, CNRN, SCRN Providence Alaska Medical Center Vicki Johnson DNP, MHSEd., ARNP Harborview Medical Center See page 5 for breakout session details 2:00PM - 2:15PM Break 2:15PM - 3:45PM 3:45PM - 4:00PM 4:00PM - 5:00PM Breakout Sessions Continued Break & Move to Back to General Session What to Do When Your Patient Almost Has a Stroke Presentation Objectives: Describe 2 differences between a TIA and a stroke Identify 2 factors of who should get an urgent (inpatient) evaluation for TIA Outline 2 steps of what workup should be performed for TIA Identify 2 factors determining what primary/secondary stroke prevention measures should be taken to decrease the risk of future stroke Michael Previti, MD Valley Medical Center 5:00PM -5:15PM Wrap Up, Surveys & Adjournment Elizabeth Peterson, RN, BSN, MPH, CHES American Heart Association/ American Stroke Association

Concurrent Breakout Sessions (Please Pick One) TIME PRESENTATION TITLE PRESENTER(S) 12:30PM - 2:00PM New Stroke Nurses: Stroke Nurse Basics Survival Guide Stroke Core Team Job Descriptions & Key Competencies Stroke Competencies Emergency Department Practitioners Stroke Unit Staff Ancillary Staff Community EMS Swallow Screen NIH Karen C. Kiesz, RN, MN, CNRN, SCRN MultiCare Health System Gena Kreiner, RN, BSN Franciscan Health System Moderator: Lisa Shumaker, BSN, RN, SCRN Providence Regional Medical Center Everett 2:00PM - 2:15PM 2:15PM - 3:45PM BREAK Stroke Performance Improvement Monthly Stroke Population, Action Plans+ Data Reports Communication & Feedback Inter-Rater Reliability Verification PI PLAN ----- Develop a Smoking Cessation Program 12:30PM - 2:00PM 2:00PM - 2:15PM 2:15PM - 3:45PM Stroke Resources Advanced Stroke Nurses: Complex Stroke Complications & Imaging in the First 36 Hours Hyperacute Phase Overview of Symptomatic Hemorrhage within the first 36 hours Case Studies: Hemorrhagic Transformation - clinically stable Hemorrhagic Transformation - clinically unstable Malignant MCA Syndrome BREAK Case Studies Continued: Hemorrhagic Transformation - ICP Monitoring Hemorrhagic Transformation - Prophylactic Hemicranectomy Hemorrhagic Transformation - Ventric/evacuation Admission to Transition of Care (Admit vs. Discharge ABCD) Christie E. Artuso, Ed.D., RN, CNRN, SCRN Providence Alaska Medical Center Vicki Johnson DNP, MHSEd., ARNP Harborview Medical Center Moderator: Louise Jenkins, MBA, BSN, RN PeaceHealth Southwest Medical Center

Faculty Biographies NAME BIOGRAPHY DISCLOSURE Christie E. Artuso, Ed.D., RN, CNRN, SCRN Providence Alaska Medical Center Julie Berdis, BSN, CNRN Providence Sacred Heart Medical Center & Planning Committee Member Kelly Boardley, RN, CEN Cascade Valley Healthcare, North Region & Planning Committee Member Christie Artuso, Ed.D., RN, CNRN, SCRN, FAHA is the Director of Neuroscience Services at Providence Alaska Medical Center. The Neuroscience Division includes a nationally-accredited stroke program, a nationally-certified concussion program, a nationally-accredited sleep disorders center, neurodiagnostic testing, and both inpatient and outpatient services for patients with neurologic and neurosurgical disorders. She has more than 35 years of educational and leadership experience in university-affiliated hospitals with recognized clinical expertise in critical care and neuroscience services. In addition to her leadership role, she currently serves as a member of the Western States Affiliate Stroke Task Force for the American Heart Association/American Stroke Association and previously served on the American Association of Critical Care Nurses (AACN) Certification Corporation Board of Directors. She is the immediate past-president of the Alaska Collaborative for Telemedicine and Telehealth and a past-president of the South Central Alaska Chapter of AACN. She earned a diploma in Nursing from Geisinger Medical Center School of Nursing in 1979 and later earned a Bachelor of Arts in Nursing at The University of the State of New York in 1986. She went on to earn a Master of Arts in Nursing at New York University in 1989, a Certificate of Advanced Graduate Study from Nova Southeastern University in 2007 and completed a Doctorate of Education in Healthcare Education from Nova Southeastern University in 2009. Her doctoral dissertation focused on the development of the telestroke program currently serving rural communities in Alaska. She is a nationally recognized speaker and an expert in the field of cardiovascular and cerebrovascular health and has published on numerous topics related to critical care and emergency medicine. In June, 2014, she was recognized by the American Heart Association as Volunteer of the Year (nonphysician) for the Western States Affiliates. Julie Berdis has been the Stroke Program Coordinator for Providence Sacred Heart Medical Center for the past 8 years and is familiar with National, Regional, local and hospital stroke protocols and guidelines. As the Stroke Coordinator, she works closely with the Providence Sacred Heart s Joint Commission Certified Primary Stroke Center team to determine needed stroke education, policies and procedures within the hospital setting, community, and region. Additionally, Julie has 27 years Neuroscience experience- Neuro and Neuro-trauma nursing and has experience as the Assistant Nurse Manager on the acute care Neurology unit. Kelly Boardley, BSN, RN, CEN is the Cardiac and Stroke Coordinator and the Emergency Department Educator at Cascade Valley Hospital and Clinics. Cascade Valley Hospital is a level 3 stroke center and a Tele-stroke partner with Harborview Medical Center. Kelly has been the Stroke Coordinator for the last 3 years at Cascade Valley Hospital and has developed the entire stroke program to include the order sets, policy and procedures, quality assurance management and hospital wide education. She has also created a community based outreach stroke education program for the local residence. She has more than 11 years of nursing experience. During this time she has worked at St. Joseph Medical Center in Tacoma WA, in the Progressive Care Unit, St. Clare Hospital in Lakewood WA, in the Emergency Department as a night shift charge nurse as well as the Emergency Department Educator. While at St. Clare she was an instructor and assisted in the development and planning of the emergency department residency. She received her Associates Nursing Degree at Everett Community College in 2003 and later earned her Bachelor of Science in Nursing from Grand Canyon University in 2013. Disclosure: s Bureau: Genentech Conflict of Interest: Resolved

Faculty Biographies NAME BIOGRAPHY DISCLOSURE Louise Jenkins, MBA, BSN, RN PeaceHealth Southwest Medical Center Planning Committee Member Vicki Johnson DNP, MHSEd., ARNP Harborview Medical Center Karen C. Kiesz, RN, MN, CNRN, SCRN MultiCare Health System & Planning Committee Member As the Neuroscience Admin Program Manager for PeaceHealth Southwest Medical Center in Vancouver, WA s Comprehensive Stroke Program, Louise Jenkins, MBA, BSN, RN is responsible for providing clinical expertise and leadership within the interdisciplinary team in development, implementation, and on-going evaluation. She works collaboratively with the physician leadership, clinical management, education department, and clinical staff to ensure overall integration throughout the organization. Additionally, she is responsible for ensuring that system and processes are developed to provide measurable improvement in clinical outcomes through the application of best practices and current technologies and provides leadership and collaboration on a system wide Process Design and Improvement team aimed at facilitating PeaceHealth employees to develop a better relationship with their job. Furthermore, she implements and sets innovative programs in place to add Lean and Quality Improvement throughout the Outpatient Clinical setting. Louise moved to the northwest in 2000 and she grew-up at PHSW for 10 years, advanced her education with a Master of Business Administration specializing in Project Management in addition to her nursing and public health degrees. She has held various positions leading to successful programs, organizational growth and developed a personal need to grow. She left the organization for three years and in that time developed a broader perspective of system management and professional growth. She returned to PHSW and feel truly, back home. As the stroke manager, as well as a survivor, she is able to empathize a patient s anxiety, frustration and blessings of small wins as well - appreciate the neuroscience professional s anxiety, frustration and blessings of small wins. Vicki Johnson has a dual role as a nurse practitioner and program manager for the UW Medicine Stroke Center at Harborview. She completed her clinical doctorate in nursing practice at the University of Washington School of Nursing, with specialization in primary and secondary stroke prevention, leadership and translating evidence into clinical practice. Her time is divided between stroke program development and direct patient care. Her clinical interests include: Patient-centered secondary stroke prevention; translation of evidence-based guidelines into care systems; and health education for those with special healthcare needs. Karen C. Kiesz RN MN CNRN SCRN is the Stroke Program Manager for MultiCare Health System (MHS). Her role in the Neuroscience Careline is the nursing leader for stroke. The stroke program at MHS includes a multi-site network of stroke hospitals as follow Tacoma General Hospital: WA State Level 1; TJC Certification as Primary Stroke Center Good Samaritan Hospital: WA State Level 2; TJC Certification as Primary Stroke Center Auburn Medical Center: WA State Level 2; TJC Certification as Primary Stroke Center Allenmore Hospital: WA State Level 3 Covington ED: Drip and Ship; transfers all stroke needing admission Karen earned and Associate Degree in Nursing from North Dakota State University in 1979; Bachelor of Science in Nursing and Master of Nursing from University of Washington Tacoma in 2000 and 2002 respectively. She worked as a clinical nurse for 17 years, primarily in critical care. After obtaining her BSN and MN degrees, she began her management career as a trauma program manager for 8 years in level 2 adult and pediatric trauma centers; transitioning to stroke program manager for the last 6 years.

Faculty Biographies NAME BIOGRAPHY DISCLOSURE Gena Kreiner, RN, BSN Franciscan Health System William H. Likosky, MD, FAAN, FAHA Swedish Medical Center Valerie Lyttle, RN MSN CEN CNRN MultiCare Good Samaritan Hospital, West Region & Planning Committee Chair Gena Kreiner is the Stroke Coordinator for Franciscan Health System. She received an Associated Degree in Nursing from Tacoma Community College in 1989 and Bachelor of Science Degree in Nursing from the University of Phoenix in 2009. She has worked with neurological patients throughout her nursing career beginning with orthopedic/neuro unit and Neuro intensive Care Unit. In 2007, Gena started the stroke program at St Joseph Medical Center (SJMC) in Tacoma, WA as well as throughout the Franciscan Health System. One of the most enjoyable things she finds to do as Stroke Coordinator is interacting with the public during community events, such as Strike Out Stroke at Cheney Stadium in Tacoma. When Gena is not at work she enjoys camping, gardening, walking (competing with friends with her Fit Bit), canoeing, making jewelry, and spending time with family and friends. William Likosky, M.D., FAAN, FAHA is the Medical Director of the Stroke and Telestroke Programs at Swedish Neuroscience Institute at Swedish Medical Center, Seattle, WA. Under his leadership, Swedish become the first hospital in the Puget Sound area to achieve Joint Commission Primary Stroke Center status The program has also received the coveted Joint Commission Codman Award for Disease Management. The Stroke Program has consistently been only one of a few nationally to receive a Sustained Achievement Award from the American Stroke Association. Dr. Likosky additionally sits on the State Health Department Technical Advisory Committee for Stroke and Heart Disease, the Northwest Regional Taskforce to establish a telehealth program for cerebral vascular disease He received his medical and neurology training at Yale Medical Center, is Board Certified in neurology and vascular neurology, and has vast research experience in vascular neurology and quality improvement. Valerie Lyttle, RN, BSN, MSN, CEN, CNRN, SCRN, is the stroke program coordinator at MultiCare Good Samaritan Hospital, a regional facility with the busiest emergency department in Pierce County and the 3 rd busiest ED in Washington State. The stroke program is a Joint Commission certified Primary Stroke Center and Washington State categorized Level 2 Stroke Center, and is part of MultiCare Health System which includes a comprehensive stroke center at Tacoma General Hospital, and rehab accredited centers at both Good Samaritan and Auburn Medical Center. Valerie began her career as an LPN in 1979, working in various ortho-med-surg units throughout Canada, earned her diploma in nursing in 1990, Bachelor of Science in Nursing from the University of Victoria (Canada) in 1992 and a Master of Science in Nursing from Walden University in 2011. Her certifications include Certified Emergency Nurse, Certified Neuroscience Registered Nurse and Stroke Certified Registered Nurse.

Faculty Biographies NAME BIOGRAPHY DISCLOSURE Matt J. Nelson Washington State Department of Health Michael Previti, MD Valley Medical Center He graduated from Central Washington University in 2005 with a Bachelor of Sciences in Psychology. He then entered the healthcare field immediately after that, accepting a position at Central Washington Hospital, now Confluence Health. He then took a position in 2006 in he Seattle area with a large durable medical equipment supplier, where he was a Sales Representative for many years managing a very large and diverse community of people. He then accepted a position at the Washington State Department of Health as the Emergency Medical Services for Children Program Manager, as well as the Emergency Cardiac and Stroke Program Coordinator. He enjoys running, hiking, and staying active. Michael Previti, MD received his medical doctorate at the University of Massachusetts after obtaining his undergraduate degree in the biological basis of behavior from the University of Pennsylvania. Dr. Previti completed his internship and neurology residency at the University of Washington, as well as a vascular neurology fellowship. He served two years as a neurohospitalist in Winston-Salem North Carolina at Forsyth Medical Center. During that time, Dr. Previti actively met with community groups to spread the word about stroke prevention and symptom recognition. I believe that public education, in addition to motivating providers to participate in a team-based approach for acute stroke care and creating and maintaining an efficient system of care for our acute and sub-acute stroke patients, can have a significant, positive impact of the community, he says. Lisa Shumaker, BSN, RN, SCRN Providence Regional Medical Center Everett Planning Committee Member Karen Young, RN, CPHQ Valley Medical Center Planning Committee Member When he s not working, Dr. Previti enjoys photography, traveling, skiing, and spending time with friends and family. Lisa Shumaker has been a RN for over 30 years. Currently she is the Stroke Program Coordinator at Providence Regional Medical Center in Everett. Lisa works with staff to plan and provide care for stroke patients, monitors the stroke program to see if we are meeting our goals, educates patients and staff about stroke and come to groups like this and present information on stroke and risks of stroke. This last fall the American Stroke Association awarded Providence with the Stroke Gold Plus Quality Achievement Award and Lisa and her team worked diligently to achieve this quality care for patients. Lisa has her Bachelors of Science in Nursing from the University of Washington. Lisa lives on acreage in Snohomish with her husband and mother. She has 3 grown sons. Karen Young has been the GWTG-Stroke data manager since 2006 here at Valley Medical Center. Valley Medical Center was certified as a Primary Stroke Center in 2005 and have successfully recertified bi-annually since then. Since 2013, Karen took on the role of Stroke Coordinator here. Our program earned the Gold Plus award with tpa Honor Roll for the first time in 2012 and renewed it in 2013. Our tpa administration rate report shows we give tpa quite a bit more often than peers in our region. On a personal note, Karen has been an RN since 1972 and her clinical background is in Coronary Intensive Care before going into case management and then Quality management.

PROGRAM PURPOSE In alignment with the Impact Goal of the American Heart Association/American Stroke Association (AHA/ASA), focused on improving the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20% by 2020, the Get With The Guidelines program (GWTG) is designed to assist healthcare professionals in institutions implementing the AHA and American College of Cardiology treatment guidelines for patients discharged with coronary artery disease (CAD), heart failure (HF), and the AHA and ASA Prevention Guidelines in patients discharged with ischemic stroke. GWTG is a comprehensive in-hospital program focusing on improving the compliance with primary and secondary prevention guidelines for cardiac and stroke patients upon discharge. Based on existing literature, improving physician compliance with medication and risk factor consultation upon discharge greatly reduces recurrent events and mortality. Evidence-based studies demonstrate marked improvement among patients when secondary prevention interventions are implemented in the hospital setting (which is referred to as the "teachable moment"). COURSE LEARNING OBJECTIVES Attendees will be able to provide examples of how the stroke patient population will benefit from the healthcare provider s adherence to the American Heart Association/American Stroke Association guidelines and explain quality improvement best practices relevant to caring for patients with stroke. Presentation specific objectives are listed in the agenda. CONTINUING EDUCATION ACCREDITATION - NURSES The American Heart Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. The maximum number of hours awarded for this CE activity is 6.50 contact hours. STEPS FOR SUCCESSFUL COMPLETION To successfully complete this activity, learners must fully participate in the sessions. In addition, learners must provide feedback that will be used for evaluative and outcomes measurement purposes. Learners will check-in onsite for attendance verification purposes and will be required to provide evaluative feedback before CME/CE credit can be claimed. POST WORKSHOP INSTRUCTIONS - COMPLETING EVALUATION & CLAIMING CE CME/CE will be available to claim online 5-7 business days post workshop. Please note that CME/CE credit will no longer be available for an activity once it has been over for more than 6 months. Following the activity, all attendees will be sent an email with a link to the Professional Education Center (PEC). Sign-in to the system using your AHA username and password. Your AHA username and password is the one you used or created when you registered for the activity online. If you did not register online, your username and password will have been sent to you in a separate email. If you did not receive the email containing your AHA username/password, please go to learn.heart.org. Click Sign In, then Forgot username/password? Complete the required evaluation survey online. Select the type of CME/CE certificate you need from the drop-down list. Modify the time you spent in the activity if applicable or leave it defaulted to the maximum available. Claim and print your CME/CE certificate on your own printer. The PEC is available at learn.heart.org.

WHO SHOULD ATTEND Nurses: Neuro, Emergency, Telemetry, Critical Care, Med/Surg, Rehab, Radiology, Intensive Care Unit, Rehab, Critical Care, Rehab, PT, OTR, Lab, Radiology, Quality, Hospital Administration REGISTER TODAY! This event made possible by The Chehalis Tribe and is provided at no cost. Please provide ALL of the following to ensure proper education credits: Name, Title, Credentials, Hospital, Address, Phone, Email For more information, please contact: JoAnne Pineda, Senior Program Director at JoAnne.Pineda@heart.org FOR DIRECTIONS OR PARKING Complimentary parking validations will be provided to participants of the Stroke Forum. The parking validations will only be valid at the airport on Floors 3, 5, 6, 7, & 8 on the day of the event.