Developing guidelines for thrombolytic therapy

The development and implementation of guidelines for the use of thrombolytic therapy at a 1000-bed community hospital are described. A thrombolytic therapy committee composed of two physicians, a nurse, and a pharmacist was established to develop the guidelines. The committee outlined goals for the guidelines, developed a format, and defined individual responsibilities. Indications, absolute requirements for use, contraindications, administration procedures, necessary tests before and during infusion, and recommendations for the use of anticoagulant therapy following thrombolytic therapy were listed. All of the committee members participated in educating the hospital staff involved with thrombolytic therapy. The pharmacist served as a liaison with the laboratory and used a flow sheet to monitor all patients receiving thrombolytic therapy. Two years after the guidelines were implemented an evaluation of physician compliance and adverse effects secondary to thrombolytic therapy showed excellent compliance (97-100% on all criteria listed) and an incidence of bleeding comparable with the values reported in the literature for heparin. The guidelines are reviewed annually by the committee and revised when necessary. The use of thrombolytic guidelines has minimized adverse effects and the misuse of laboratory tests, assisted with proper patient selection, and united several disciplines in a collaborative fashion toward a common goal.