2.50
Hdl Handle:
http://hdl.handle.net/10755/344157
Category:
Abstract
Type:
Poster
Title:
Meet Me in CT - Decreasing Door to tPA Time
Author(s):
Speirs, Lauri; Mitchell, Anne
Lead Author STTI Affiliation:
Non-member
Author Details:
Lauri Speirs, MSN, RN, CNRN, CNS-BC, CSRN, PCCN, laurifred1960@yahoo.com; Anne Mitchell, MSN, RN, CEN, CCRN, CNS-BC
Abstract:
Evidence-based Practice Abstract Purpose: Primary Stroke Center certification requires strict adherence to patient care guidelines, including rapid evaluation of patients who may be candidates for tissue plasminogen activator (t-PA) therapy. The American Stroke Association recommendation for t-PA door to needle time is 60 minutes. In spite of a well-established Stroke Alert process, the average door to needle time exceeded the 60 minute goal by 15 minutes in first quarter of 2013. The facility stroke committee determined to improve t-PA administration times for ischemic stroke patients arriving by ambulance. Design: Process improvement project to decrease door to drug time for ischemic stroke patients meeting criteria for t-PA, based on evidence in literature and from other stroke centers. Setting: Emergency Department of a community, nonprofit, primary stroke center licensed for 343 beds. Participants/Subjects: Multidisciplinary stroke team members: ED physician, stroke neurologist, stroke CNS, ED and stroke responder RNs, EMS, laboratory and CT personnel. Methods: The facility stroke committee analyzed each component of the stroke alert process to determine improvement opportunities. Review revealed door to CT read times occurred within the recommended 45 minutes only 66% of the time, well below the recommended 85%, and contributed to prolonged door to needle times. Normally the stroke team met the patient and ambulance crew in an ED patient room. The patient was transferred to the bed, connected to the cardiac monitor, venous access established, blood specimens collected, and a 12 lead electrocardiogram (EKG) done. The patient was then transported to the CT scanner. Performing non-essential tasks prior to transporting the patient to the CT scanner was the most common reason for extended CT read times, which delayed completion of the CT exam, availability of results, and the decision to administer t-PA. Redesign of the initial process required our stroke team to meet the ambulance crew and patient at the CT scanner. Care was transferred, the patient assessed by the stroke team, and the patient placed in the scanner and CT completed. After CT completion, the patient was transferred to an ED bed, connected to the cardiac monitor and other diagnostic tests were completed. Postponing nonessential care until after the CT eliminated the delays incurred when the patient was placed in an ED room prior to the CT. Results/Outcomes: Preliminary data collected during the first six months after implementation of the new process indicate CT door to result time met the 45 minute goal 83% of the time compared to 66% prior to process redesign, a significant improvement. For those who arrived by EMS, door to needle time also decreased by nearly 10 minutes. Implications: The CT exam results are essential to the t-PA treatment decision and delays extend the door to needle time. Taking the stroke patient immediately to the CT scanner and then placing them in an ED bed and performing non-critical tasks, can improve door to CT read times and shorten door to t-PA administration time for ischemic stroke patients.
Keywords:
Door to t-PA time; Door to needle time
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.titleMeet Me in CT - Decreasing Door to tPA Timeen_GB
dc.contributor.authorSpeirs, Laurien_GB
dc.contributor.authorMitchell, Anneen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsLauri Speirs, MSN, RN, CNRN, CNS-BC, CSRN, PCCN, laurifred1960@yahoo.com; Anne Mitchell, MSN, RN, CEN, CCRN, CNS-BCen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344157-
dc.description.abstractEvidence-based Practice Abstract Purpose: Primary Stroke Center certification requires strict adherence to patient care guidelines, including rapid evaluation of patients who may be candidates for tissue plasminogen activator (t-PA) therapy. The American Stroke Association recommendation for t-PA door to needle time is 60 minutes. In spite of a well-established Stroke Alert process, the average door to needle time exceeded the 60 minute goal by 15 minutes in first quarter of 2013. The facility stroke committee determined to improve t-PA administration times for ischemic stroke patients arriving by ambulance. Design: Process improvement project to decrease door to drug time for ischemic stroke patients meeting criteria for t-PA, based on evidence in literature and from other stroke centers. Setting: Emergency Department of a community, nonprofit, primary stroke center licensed for 343 beds. Participants/Subjects: Multidisciplinary stroke team members: ED physician, stroke neurologist, stroke CNS, ED and stroke responder RNs, EMS, laboratory and CT personnel. Methods: The facility stroke committee analyzed each component of the stroke alert process to determine improvement opportunities. Review revealed door to CT read times occurred within the recommended 45 minutes only 66% of the time, well below the recommended 85%, and contributed to prolonged door to needle times. Normally the stroke team met the patient and ambulance crew in an ED patient room. The patient was transferred to the bed, connected to the cardiac monitor, venous access established, blood specimens collected, and a 12 lead electrocardiogram (EKG) done. The patient was then transported to the CT scanner. Performing non-essential tasks prior to transporting the patient to the CT scanner was the most common reason for extended CT read times, which delayed completion of the CT exam, availability of results, and the decision to administer t-PA. Redesign of the initial process required our stroke team to meet the ambulance crew and patient at the CT scanner. Care was transferred, the patient assessed by the stroke team, and the patient placed in the scanner and CT completed. After CT completion, the patient was transferred to an ED bed, connected to the cardiac monitor and other diagnostic tests were completed. Postponing nonessential care until after the CT eliminated the delays incurred when the patient was placed in an ED room prior to the CT. Results/Outcomes: Preliminary data collected during the first six months after implementation of the new process indicate CT door to result time met the 45 minute goal 83% of the time compared to 66% prior to process redesign, a significant improvement. For those who arrived by EMS, door to needle time also decreased by nearly 10 minutes. Implications: The CT exam results are essential to the t-PA treatment decision and delays extend the door to needle time. Taking the stroke patient immediately to the CT scanner and then placing them in an ED bed and performing non-critical tasks, can improve door to CT read times and shorten door to t-PA administration time for ischemic stroke patients.en_GB
dc.subjectDoor to t-PA timeen_GB
dc.subjectDoor to needle timeen_GB
dc.date.available2015-02-04T11:27:31Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:31Z-
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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