Identifying errors and safety considerations in patients undergoing thrombolysis for acute ischemic stroke

Area of Science:

• Neurology
• Pharmacology
• Patient Safety

Background:

• Alteplase is a critical thrombolytic agent for acute ischemic stroke (AIS).
• Alteplase is classified as a high-alert medication, increasing the potential for administration errors.
• Variations in error rates between different healthcare settings warrant investigation.

Purpose of the Study:

• To compare medication error rates of alteplase administration for AIS between regional hospitals and a Comprehensive Stroke Center (CSC).
• To identify potential associations between alteplase administration errors and adverse patient outcomes.

Main Methods:

• Retrospective cohort study of adult patients receiving intravenous alteplase for AIS (June 2015-June 2018).
• Data collected from institutional databases; medication errors classified using a standardized taxonomy.
• Comparison of error rates and outcomes between patients treated at regional hospitals versus the CSC.

Main Results:

• A total of 676 patients received alteplase; 19.8% of administrations involved medication errors.
• Error rates were significantly higher in regional hospitals (18.2%) compared to the CSC (1.6%).
• Patients with alteplase administration errors had a higher incidence of hemorrhagic conversion (12.7%) than those without errors (7.2%, p=0.04).

Conclusions:

• The overall rate of alteplase infusion errors for AIS is high, with a disproportionate burden on referring regional centers.
• Alteplase administration errors are associated with increased risk of adverse events, specifically hemorrhagic conversion.
• Enhanced education and implementation of administration safeguards are crucial to mitigate medication errors and improve patient safety.