Background:

The triage process contributes to early stroke treatment, reducing mortality and disability.

Objective:

To analyze nurses' difficulties in triage and activating the Code Stroke protocol.

Method:

Descriptive and cross-sectional study. The data were collected, by convenience sampling, in an emergency medical-surgical service through a questionnaire.

Results:

The sample included 21 nurses (39.7±7.4 years), mostly women (71.4%). In terms of professional experience, the working time in emergency department was 9.5 (±6.2 years).

The verbal and physical violence of patients and family members was the most mentioned difficulty regarding triage. About 29% partially and 19% fully agree that inadequate information about two symptoms at the time of onset constitutes a difficulty in activating the Code Stroke.

Conclusion:

Triage and the Stroke Code protocol are considered facilitators of care, with sporadic difficulties in some phases of the process.