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Streamlining the Process for Intravenous Tissue Plasminogen Activator.

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The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses
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Summary
This summary is machine-generated.

Implementing a dedicated stroke nurse and nursing flow sheet significantly improved treatment times for acute ischemic stroke patients. This intervention increased the percentage of patients receiving intravenous tissue plasminogen activator (IV tPA) within 60 minutes.

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Healthcare Quality Improvement

Background:

  • Rapid administration of intravenous tissue plasminogen activator (IV tPA) is crucial for improving recovery outcomes in ischemic stroke patients.
  • Stroke centers face challenges in consistently achieving the target door-to-needle time of under 60 minutes.

Purpose of the Study:

  • To evaluate the impact of implementing a dedicated stroke nurse and nursing flow sheet on door-to-needle times for acute stroke patients.
  • To determine if this intervention increases the proportion of patients treated with IV tPA within 60 minutes of hospital arrival.

Main Methods:

  • A pre- and post-intervention study design was used, collecting data from 138 ischemic stroke patients treated between 2009 and 2013.
  • The intervention involved adding a dedicated stroke nurse and a nursing flow sheet to streamline acute stroke patient assessment and treatment.
  • Statistical analysis using Student t tests and χ tests compared door-to-needle times before and after the intervention.

Main Results:

  • The percentage of patients treated with IV tPA within 60 minutes significantly improved from 28% pre-intervention to 52% post-intervention (P = .005).
  • The mean door-to-needle time decreased slightly from 82 to 78 minutes, though this was not statistically significant (P = .583).
  • Factors such as stroke severity and the need for additional imaging were associated with longer treatment times.

Conclusions:

  • The integration of a dedicated stroke nurse and a standardized nursing flow sheet is an effective strategy for increasing the proportion of ischemic stroke patients treated within the critical 60-minute window.
  • This quality improvement initiative enhances the efficiency of acute stroke care delivery.