Virtual Tipsheets

To define the roles and accountabilities of the health care team in the care of patients when the Behavioral Emergency Response Team (BERT) or Behavioral Optimization and Outcomes Support Team (BOOST) are activated.

• Behavioral Crisis: Any situation where the patient has been identified by staff as harmful or threatening to the personal safety of patients, visitors, or staff.
• Safety Huddle: Brief meeting of all BERT members, Primary RN, and LIP before interacting with the patient to discuss reason for call and relevant history.
• Debriefing: Occurs after conclusion of the behavioral crisis to review events and discuss recommendations for continued care.

• Notify primary LIP before activating BERT unless imminent violence is present — in that case, notify immediately after activation.
• Remain at bedside for duration of the behavioral event.
• Provide pertinent information not discussed during safety huddle.
• Retrieve/delegate retrieval and administration of stat medications ordered.

• Describe events leading up to team activation.
• Comment on patient's recent mental status and any disruption to sleep-wake cycle.
• Assist in management of the environment of care during event.

• Safety Huddle: Identify self as team leader, guide clinical summary discussion, determine duration of huddle prior to patient interaction.
• During Crisis: Direct and delegate activities, collaborate with LIP and RN, advise on restraint protocols.
• Debriefing: Lead debrief, discuss etiology, recommend changes to primary care team, review documentation, assess need for daily behavioral safety huddle.

To promote an environment of safety for the adult patient population by identifying patients at risk for falls and minimizing the potential for injury.

• Assess fall risk using the Morse Falls Risk Assessment Scale.
• Assess adult patient's injury risk using the ABCS tool.
• Collaborate with medical team, patient, and family to develop the fall prevention plan of care.
• Educate patient and family on risk reduction and injury prevention using teach-back.

1. Assess for injury to determine whether patient should be moved and notify MD/NP/PA immediately.
2. Assist with immobilizing patient if head and neck pain/injury is suspected or reported.
3. Assess if patient struck head or is high risk for injury; monitor vital signs/neuro checks per Addendum A parameters.
4. Assess safety of environment and modify as needed.
5. Reassess fall risk.
6. Consider patient for Virtual Constant Observation (VCO) per protocol criteria.

• Document in the EMR with a revision of the care plan demonstrating risk reduction strategies.
• Document the fall in the occurrence reporting system.

To provide guidance in caring for patients who experience hypoglycemia.

• Pallor, shakiness, tachycardia, palpitations, hunger (note: beta-blocker patients may not exhibit these)
• Paresthesia, diaphoresis, inability to concentrate, confusion, slurred speech
• Irrational behavior, slowed reaction time, blurred vision, somnolence, extreme fatigue
• Severe: Loss of consciousness, inability to arouse from sleep, seizures

• Adult patients: initial BG <70 mg/dL
• Pregnant patients: initial BG <60 mg/dL
• Patient reports signs or symptoms of hypoglycemia

• Give meal or snack within 30 minutes of BG reaching ≥70 (or ≥60 in pregnancy).
• Check BG 60 minutes after meal or snack.

• Start/End of hypoglycemia protocol
• Precipitating factors and symptoms
• Initial BG levels, treatment, patient response
• BG levels during and following treatment at times outlined

• Complete initial TAPS Tool screening in the ED for admitted patients.
• Complete CIWA-Ar/RASS if indicated.
• Document scores in the Electronic Health Record (EHR).
• Administer medications as ordered.
• On arrival to inpatient unit: confirm TAPS was completed; if not, complete on admission. Repeat CIWA-Ar/RASS per protocol and notify MD/NP/PA. Ensure labs, Social Work notification, Fall Precautions, and CIWA-Ar communication during hand-off.

• Score = 0: No further action.
• Score = 1: Notify MD/NP/PA; order Social Work consult.
• Score ≥ 2: Complete CIWA-Ar or RASS; order Social Work consult (Addictions team at Tisch); notify MD/NP/PA for orders; initiate falls, airway, and seizure precautions as needed; monitor vitals minimum Q4h.

*For patients in ED or ICU, notify Attending Physician who will determine if RRT is indicated.

• TAPS score ≥1 in Sedative category: Complete CIWA-Ar, order Social Work consult, notify MD/NP/PA, initiate fall precautions, monitor vitals Q4h minimum.
• CIWA-Ar ≥8: Notify MD/NP/PA.
• CIWA-Ar >15: Call RRT, call emergency psychiatry consult, initiate airway and seizure precautions, obtain labs/urine per MD order.
• Continue CIWA-Ar until all assessments <8 for 48 consecutive hours.

• Regular inpatient/observation units: Minimum Q6h; 1 hour after PO treatment; 15–30 min after IV treatment.
• SDU/ICU: Minimum Q2h; 15–30 min after each IV treatment.

The NYU Langone Stroke Program is committed to providing advanced therapies to patients who have suffered or are at risk of suffering a stroke and to prevent death or disability from stroke through a multidisciplinary team of specialists, evidence-based care, clinical trials, and education.

• Anyone at NYULH can activate the Stroke Team.
• Dial 33-911 and ask operator to activate the Stroke Team.
• ED: Activate for any patient with sudden onset stroke symptoms within 6 hours of last known well, or 6–24 hours with NYU ED Stroke Scale >2.
• Inpatient: Activate for any patient with sudden onset stroke symptoms within 24 hours or wake-up stroke.

• Neurologist
• Neurology Resident
• Pharmacist (as available)
• ALERT Team RN (inpatient only)
• Vascular Neurology Fellow (as available)
• Stroke Coordinator (as available)

• Last known well time
• NYC S-LAMS Score (Facial Droop · Arm Drift · Speech Deficit · Grip Strength)

• Stroke Team available 24/7 at cell: 347-802-6766
• Check treatment team in Epic for the assigned provider.
• Secure chat should only be used for non-emergent issues.
• Dedicated Neuro ICU: Kimmel 16 — staffed with APPs 24/7 for neuro-critical care.

• Management of Patients Receiving Thrombolytic Therapy
• Stroke Response Team Protocol – ED
• Stroke Response Team Protocol – Inpatient
• Stroke Discharge Process
• Stroke Program Overview

Access at: nyumc.ellucid.com → Browse Manuals → Stroke Policy and Procedure Manual