5.00
Hdl Handle:
http://hdl.handle.net/10755/344149
Category:
Abstract
Type:
Poster
Title:
Minutes Matter: Team Approach to Reducing "DTN" in Acute Stroke
Author(s):
Brooks, Joy; Reed Jones, Robin; Landers, Adam
Lead Author STTI Affiliation:
Non-member
Author Details:
Joy Brooks, MSN, RN, CEN, cedjxb@msj.org; Robin Reed Jones, RN, CNRN; Adam Landers, PharmD, BCPS, CPP
Abstract:
Evidence-based Practice Abstract Purpose: The ED has a dedicated pharmacist from 9am to 1am. This pharmacist would respond to all Code Stroke patients who presented to the ED. When tPA was need it was mixed in the hospital core pharmacy by the ED pharmacist and brought immediately to the bedside. After 1am a hospital pharmacist would mix the drug and bring to the ED. It was noted that door to needle times were increasing during these times. No tPA was kept in the ED medication station. Best practice is a door to needle time of < 60 minutes. It was hypothesized that having tPA in the ED for bedside mixing would decrease these times . Design: This was a non- experimental study. Data was collected by retrospective chart review . Setting: 61 bed ED in a Level II Trauma Center. This facility is a designated Primary Stroke Center. Participants/Subjects: The population of this study were those patients who were diagnosed with Ischemic stoke and met the inclusion criteria for tPA administration. Excluded were those strokes who were hemorrhagic or outside the window for administration. This was a non-experimentall study. There were no manipulation of the variables that would affect the patient or outcomes. Other participants were the emergency department staff, pharmacist and hospital Stroke Coordinator. Methods: Data was shared with an interdisciplinary team including MDs, bedside RNs, clinical pharmacist , Ed management and Stroke Team. Approval was given to begin the bedside mixing of tPA in the emergency department. A policy was written to support this decision. A core group of emergency department staff were chosen to begin the process. A video from the drug company was assigned to each chosen staff member. A hands-on demonstration of mixing was observed by this educator. All steps in the process had to be followed to pass the competency. Dosing , contraindications and side effects were also reviewed. A "code stroke kit" was placed in several areas of the emergency department which included all necessary items needed for rapid mixing. When a Code Stroke was called this kit was brought to the bedside. No time was spent looking for items needed. The mixing nurse and the bedside nurse doubled-checked the dose at the bedside before administration. The waste dose was taken out of the room before the bolus dose was removed so no mistakes were made. Results/Outcomes: The review of the outcomes is ongoing. Average door to needle time has decreased by 4.9 minutes. Some patients have been treated in less than 25 minutes. Education has now included the hospital-based flight crew so tPA can be mixed prior to loading the ischemic stroke patients they transport to this facility. There were some outliers on some patients which skewed the data causing a multi-modal distribution. Implications: Opportunities for education of staff were recognized. Rapid mobilization of staff and recognition of the ischemic stroke patient is vital to decreasing the door to needle time.This facility was renamed a Primary Stroke Center after a Joint Commission review in October, 2013. Competency verification will be repeated yearly.
Keywords:
Door-to-Needle Time; Reducing "DTN"
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleMinutes Matter: Team Approach to Reducing "DTN" in Acute Strokeen_GB
dc.contributor.authorBrooks, Joyen_GB
dc.contributor.authorReed Jones, Robinen_GB
dc.contributor.authorLanders, Adamen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsJoy Brooks, MSN, RN, CEN, cedjxb@msj.org; Robin Reed Jones, RN, CNRN; Adam Landers, PharmD, BCPS, CPPen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344149-
dc.description.abstractEvidence-based Practice Abstract Purpose: The ED has a dedicated pharmacist from 9am to 1am. This pharmacist would respond to all Code Stroke patients who presented to the ED. When tPA was need it was mixed in the hospital core pharmacy by the ED pharmacist and brought immediately to the bedside. After 1am a hospital pharmacist would mix the drug and bring to the ED. It was noted that door to needle times were increasing during these times. No tPA was kept in the ED medication station. Best practice is a door to needle time of < 60 minutes. It was hypothesized that having tPA in the ED for bedside mixing would decrease these times . Design: This was a non- experimental study. Data was collected by retrospective chart review . Setting: 61 bed ED in a Level II Trauma Center. This facility is a designated Primary Stroke Center. Participants/Subjects: The population of this study were those patients who were diagnosed with Ischemic stoke and met the inclusion criteria for tPA administration. Excluded were those strokes who were hemorrhagic or outside the window for administration. This was a non-experimentall study. There were no manipulation of the variables that would affect the patient or outcomes. Other participants were the emergency department staff, pharmacist and hospital Stroke Coordinator. Methods: Data was shared with an interdisciplinary team including MDs, bedside RNs, clinical pharmacist , Ed management and Stroke Team. Approval was given to begin the bedside mixing of tPA in the emergency department. A policy was written to support this decision. A core group of emergency department staff were chosen to begin the process. A video from the drug company was assigned to each chosen staff member. A hands-on demonstration of mixing was observed by this educator. All steps in the process had to be followed to pass the competency. Dosing , contraindications and side effects were also reviewed. A "code stroke kit" was placed in several areas of the emergency department which included all necessary items needed for rapid mixing. When a Code Stroke was called this kit was brought to the bedside. No time was spent looking for items needed. The mixing nurse and the bedside nurse doubled-checked the dose at the bedside before administration. The waste dose was taken out of the room before the bolus dose was removed so no mistakes were made. Results/Outcomes: The review of the outcomes is ongoing. Average door to needle time has decreased by 4.9 minutes. Some patients have been treated in less than 25 minutes. Education has now included the hospital-based flight crew so tPA can be mixed prior to loading the ischemic stroke patients they transport to this facility. There were some outliers on some patients which skewed the data causing a multi-modal distribution. Implications: Opportunities for education of staff were recognized. Rapid mobilization of staff and recognition of the ischemic stroke patient is vital to decreasing the door to needle time.This facility was renamed a Primary Stroke Center after a Joint Commission review in October, 2013. Competency verification will be repeated yearly.en_GB
dc.subjectDoor-to-Needle Timeen_GB
dc.subjectReducing "DTN"en_GB
dc.date.available2015-02-04T11:27:23Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:23Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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