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Streamlining the Process for Intravenous Tissue Plasminogen Activator

Lawrence, Erin; Merbach, Dawn; Thorpe, Sherry; Llinas, Rafael H.; Marsh, Elisabeth B.

Journal of Neuroscience Nursing: February 2018 - Volume 50 - Issue 1 - p 37–41
doi: 10.1097/JNN.0000000000000337
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ABSTRACT Background: For ischemic stroke, the chance of improved recovery is directly impacted by length of time from symptom onset to administration of intravenous tissue plasminogen activator (IV tPA). Despite the importance of rapid treatment, stroke centers struggle with achieving consistent door-to-needle times of less than 60 minutes. Methods: We implemented a change in our response to the acute stroke patient by adding a dedicated stroke nurse and a nursing flow sheet focused on critical benchmarks before treatment. We collected data on patients treated with IV tPA preintervention and postintervention to determine whether our process increased the number of patients receiving tPA in less than 60 minutes. One hundred thirty-eight patients (n = 78 pre and 60 post) treated between 2009 and 2013 were included. Student t tests and χ2 tests were used to compare door-to-needle times preintervention and postintervention. Results: By implementing this new approach, the mean time to treatment decreased from 82 to 78 minutes (P = .583). The percentage of patients successfully treated within 60 minutes of arrival improved from 28% to 52% (P = .005). Stroke severity and need for additional imaging were associated with increased time to treatment. Conclusion: The use of a stroke nurse and a nursing flow sheet as part of the acute stroke assessment significantly increases the proportion of patients treated with IV tPA within 60 minutes from hospital arrival.

Questions or comments about this article may be directed to Elisabeth B. Marsh, MD, at ebmarsh@jhmi.edu. She is an Associate Professor of Neurology, Department of Neurology, Johns Hopkins, Baltimore, MD.

Erin Lawrence, MSN, is Stroke Coordinator, Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD.

Dawn Merbach, MSN, is Stroke Nurse, Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD.

Sherry Thorpe, MSN, is Manager, Department Interventional Radiology, Johns Hopkins Bayview Medical Center, Baltimore, MD.

Rafael H. Llinas, MD, is Professor of Neurology, Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD.

The authors declare no conflicts of interest.

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© 2018 American Association of Neuroscience Nurses