2.50
Hdl Handle:
http://hdl.handle.net/10755/306582
Category:
Abstract
Type:
Poster
Title:
Bust That Clot! Alteplase within 60 minutes: See It! Own It! Do It!
Author(s):
Rhew, Denise; Clark, Katherine; Ashcraft, Susan; Mintimer, Rita; Britt, Debra
Lead Author STTI Affiliation:
Non-member
Author Details:
Denise Rhew, MSN, RN, CEN, denise.rhew@conehealth.com; Katherine Clark, BSN, RN, CEN; Susan Ashcraft, MSN,RN,ACNS-BC; Rita Mintimer, BSN, RN, CNRN; Debra Britt, BSN, RN, CCRN
Abstract:

Evidence-based Practice Abstract

Purpose: The decision making process prior to administration of the clot busting medication, Alteplase is complex. Identifying roles and responsibilities of the emergency department staff are critical in order to provide safe and timely administration of Alteplase. The purpose of the team was to identify role responsibilities and points of essential communication of information to improve identification and delivery of Alteplase to eligible stroke patients. Current timely identification and administration was 60 percent. The hospital set the goal to administer Alteplase within 60 minutes of presentation to the hospital at 75 percent of eligible patient to improve neurological function and reduce disability.

Design: The use of a model for evidence-based practice guided this staff development project. A team was formed to analyze processes and components to improve patient outcomes.

Setting: A private, not-for-profit Level II Trauma center seeing greater than 100,000 patients per year in the emergency department setting. Number of ischemic stroke patients seen is approximately 1000 per year.

Participants/Subjects: The team consisted of a neuroscience clinical nurse specialist, rapid response nurse, pharmacist, clinical educator, emergency department nurse, stroke coordinator and phlebotomist. The subjects were patients entering the emergency department who were identified as having an ischemic stroke and met inclusion criteria to receive Alteplase.

Methods: Analysis of patients receiving Alteplase during 2011 revealed 64.8 percent of Alteplase was administration during late afternoon and evening hours when stroke team resources were most lean. The importance of communication between the emergency department staff and responding stroke team was identified. After flow-charting the code stroke process of a patient entering the emergency department, the team color diagramed responsibilities for key processes and points of intentional communication required between team members regardless of time of day stroke patients presented to the hospital. Processes that can cause delay in administration were identified during this analysis such as; blood pressure management, identifying the eligible patient’s last seen normal time, and communication barriers of the team. Each department and staff member involved in the process received education of their specific responsibilities.

Results/Outcomes: In the first six months after staff education and acknowledgement of their roles and required points of communication, 73 percent (46 of 63) of eligible stroke patients received treatment with Alteplase within the goal of 60 minutes. The median time from patient presentation to Alteplase administration dropped to 52 minutes from 58 minutes, suggesting decrease in variability of the process. The education provided to the staff decreased potential delays and enhanced inter-professional collaboration.

Implication: Defining role responsibilities to ensure effective communication among stroke team members improves time to treatment decisions in eligible stroke patients. Recommendations were made to have 24 hour stroke team availability due to the percent of stroke patients who received Alteplase in the evening hours. Other recommendations were to add atomic clocks to the critical emergency room beds and to have the primary nurse carry a 60 minute timer to remind them of the time constraints.

Keywords:
Administration of Alteplase in the ED
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleBust That Clot! Alteplase within 60 minutes: See It! Own It! Do It!en_GB
dc.contributor.authorRhew, Deniseen_GB
dc.contributor.authorClark, Katherineen_GB
dc.contributor.authorAshcraft, Susanen_GB
dc.contributor.authorMintimer, Ritaen_GB
dc.contributor.authorBritt, Debraen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsDenise Rhew, MSN, RN, CEN, denise.rhew@conehealth.com; Katherine Clark, BSN, RN, CEN; Susan Ashcraft, MSN,RN,ACNS-BC; Rita Mintimer, BSN, RN, CNRN; Debra Britt, BSN, RN, CCRNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306582-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: The decision making process prior to administration of the clot busting medication, Alteplase is complex. Identifying roles and responsibilities of the emergency department staff are critical in order to provide safe and timely administration of Alteplase. The purpose of the team was to identify role responsibilities and points of essential communication of information to improve identification and delivery of Alteplase to eligible stroke patients. Current timely identification and administration was 60 percent. The hospital set the goal to administer Alteplase within 60 minutes of presentation to the hospital at 75 percent of eligible patient to improve neurological function and reduce disability.</p><p>Design: The use of a model for evidence-based practice guided this staff development project. A team was formed to analyze processes and components to improve patient outcomes.</p><p>Setting: A private, not-for-profit Level II Trauma center seeing greater than 100,000 patients per year in the emergency department setting. Number of ischemic stroke patients seen is approximately 1000 per year.</p><p>Participants/Subjects: The team consisted of a neuroscience clinical nurse specialist, rapid response nurse, pharmacist, clinical educator, emergency department nurse, stroke coordinator and phlebotomist. The subjects were patients entering the emergency department who were identified as having an ischemic stroke and met inclusion criteria to receive Alteplase.</p><p>Methods: Analysis of patients receiving Alteplase during 2011 revealed 64.8 percent of Alteplase was administration during late afternoon and evening hours when stroke team resources were most lean. The importance of communication between the emergency department staff and responding stroke team was identified. After flow-charting the code stroke process of a patient entering the emergency department, the team color diagramed responsibilities for key processes and points of intentional communication required between team members regardless of time of day stroke patients presented to the hospital. Processes that can cause delay in administration were identified during this analysis such as; blood pressure management, identifying the eligible patient’s last seen normal time, and communication barriers of the team. Each department and staff member involved in the process received education of their specific responsibilities.</p><p>Results/Outcomes: In the first six months after staff education and acknowledgement of their roles and required points of communication, 73 percent (46 of 63) of eligible stroke patients received treatment with Alteplase within the goal of 60 minutes. The median time from patient presentation to Alteplase administration dropped to 52 minutes from 58 minutes, suggesting decrease in variability of the process. The education provided to the staff decreased potential delays and enhanced inter-professional collaboration.</p><p>Implication: Defining role responsibilities to ensure effective communication among stroke team members improves time to treatment decisions in eligible stroke patients. Recommendations were made to have 24 hour stroke team availability due to the percent of stroke patients who received Alteplase in the evening hours. Other recommendations were to add atomic clocks to the critical emergency room beds and to have the primary nurse carry a 60 minute timer to remind them of the time constraints.</p>en_GB
dc.subjectAdministration of Alteplase in the EDen_GB
dc.date.available2013-12-09T17:00:11Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:11Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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