Tissue Plasminogen Activator Prescription and Administration Errors within a Regional Stroke System

Area of Science:

• Neurology
• Emergency Medicine
• Pharmacology

Background:

• Intravenous tissue plasminogen activator (tPA) is crucial for acute ischemic stroke (AIS) treatment, requiring precise weight-based dosing and infusion rates.
• Minimizing tPA dosing errors is a priority in stroke care networks.
• This study examines the incidence and types of tPA administration errors in a comprehensive stroke center (CSC) and community hospitals (CHs).

Purpose of the Study:

• To determine the frequency and nature of IV tPA administration errors in AIS patients.
• To compare error rates between a CSC and CHs.
• To assess the association between tPA errors and patient outcomes.

Main Methods:

• A stroke quality database was used to extract data on IV tPA administration from 2010-2011.
• Records were analyzed for deviations from inclusion/exclusion criteria and errors in tPA prescription, reconstitution, dispensing, or administration.
• Outcomes including parenchymal hematoma, mortality, and modified Rankin Scale scores were evaluated.

Main Results:

• Of 131 AIS cases, 64% had tPA prescription or administration errors, with higher rates in CHs (75%) compared to the CSC (41%).
• Incorrect dosage based on body weight was the most common error (55% in CHs, 19% in CSC).
• Despite 27 overdoses, including 3 deaths, no significant difference in outcomes was observed between CSC and CH patients, or between those with and without errors.

Conclusions:

• tPA administration errors are prevalent in regional stroke systems, particularly in CHs.
• While this study did not demonstrate a direct link between tPA errors and adverse outcomes, the high error rate underscores the need for robust quality assurance.
• Continuous efforts are necessary to minimize potentially harmful and avoidable medication errors in AIS treatment.