Based on medical record review, document review and interview, it was determined the hospital failed to ensure that the staff in the emergency department (ED) followed its policies for: (a) timely management of patients' acute stroke symptoms, and (b) reassessment of patients' elevated blood pressure. This was found in 2 (two) of 10 medical records reviewed (Patient #1, Patient #3). Findings include: Review of the medical record for Patient #1 noted: the patient presented on January 28, 2016 at 1:49 PM with a complaint of headache since 10:00 AM that morning, left upper extremity tingling, heaviness and facial numbness and left foot numbness. The patient had been sent to the ED by her primary doctor, for a stroke evaluation. The triage was completed at 2:12 PM, twenty-three minutes after arrival and the patient was seen by an ED doctor at 2:25 PM, who noted the patient had blurred vision, "squiggly lines," numbness, tingling and paresthesia (burning or prickling sensation) to the left side of her body. The stroke team was activated at 2:29 PM, forty minutes after the patient's arrival in the ED. The facility's policy titled "Guidelines for Management of Acute Stroke Patients," last reviewed 10/2014, states, "For acute stroke patients (presenting within 6 hours of onset), activate the Code Stroke system. The stroke team will arrive within 10 minutes of notification for urgent assessment and management." The policy further states urgent assessment and management includes "neurologic screening examination, including an NIHSS." (The National Institutes of Health Stroke Scale). These policies were not followed as required by its stroke designation status and staff did not activate the Code Stroke system in a timely manner to manage the patient's acute stroke symptoms. The "NIH Stroke scale" form was signed but an assessment was not documented on the form. These findings were shared with the Director, Patient Safety on April 29, 2016 at 3:30 PM. Review of the medical record for Patient #3 noted the following: patient presented on March 17, 2016 at 1:39 PM with a complaint of "chest, neck and back pain x 1 hour." The patient's pain score was 2 (on a scale of 0 - no pain, to 10 - most severe pain); blood pressure 169/101 (normal adult range 120/80 mmHg). The patient's previous medical history was significant for Hypertension and he had taken Aspirin as an anticoagulant. The patient was sent to the waiting area and documentation at 4:11 PM (approximately 2 hours 30 minutes after arrival in the ED) revealed the patient was "called in the waiting room. No answer." There was no documentation that the patient's elevated blood pressure was reassessed while the patient was waiting in the ED. This is not in compliance with the facility's policy titled "Vital Signs," last revised 08/15, which states, "vital signs are reassessed on all patients when vital signs are not within normal limits." The policy further states vital signs should be repeated "to determine if any change in patient condition has occurred." These findings were shared with the Director, Patient Safety on April 26, 2016 at approximately 2:00 PM.