2.50
Hdl Handle:
http://hdl.handle.net/10755/344160
Category:
Abstract
Type:
Poster
Title:
Reducing Door to Needle Times in Acute Ischemic Stroke Patients
Author(s):
Jones, Beverly; Bodine, Jennifer; McKinness, Angel
Lead Author STTI Affiliation:
Non-member
Author Details:
Beverly Jones, DNP, ACNP, CCRN, bjonesnp13@gmail.com; Jennifer Bodine, MHA, MSN, RN, CEN; Angel McKinness, MSN, RN
Abstract:
Evidence-based Practice Abstract Purpose: Intravenous plasminogen activator (t-PA) is an accepted and proven intervention in patients with acute ischemic stroke. The benefits of t-PA in acute ischemic stroke are time dependent and current guidelines recommend a door to needle time of less than 60 minutes. Despite the strong evidence and recommendations, recent studies indicate that less than one third of patients are given intravenous plasminogen activator or t-PA within the sixty-minute window. The clinical process is complex and involves many different clinical departments to work together to achieve this goal. The Target: Stroke Initiative was used as the foundation for this performance improvement initiative. Our goal was to design a process for our emergency department that would improve door to needle times in acute ischemic stroke patients. Design: Performance Improvement Initiative. Setting: 44 bed urban emergency department with an annual volume of 45,000 patients. Participants/Subjects: Emergency department physicians, Neurologists, Radiologists, Nursing staff, Laboratory staff, Pharmacists. Methods: Utilizing a FOCUS-PDCA framework the performance improvement project was developed to analyze performance measures and identify barriers to meeting the door to needle time of sixty minutes. A number of processes were put in place. One involved implementing a Code Stroke Policy to establish guidelines for healthcare providers to rapidly identify and initiate treatment for patients experiencing symptoms of acute stroke. A second involved educational sessions for physicians as well as nursing staff to identify treatment of patients with t-PA. A third initiative included implementation of an annual t-PA skills check off required for the emergency department staff, medical response team and select Intensive Care Unit nurses to apply the knowledge taught. Weekly debriefing sessions with the multidisciplinary stroke team identified barriers to t-PA compliance and administration within 60 minutes. Results/Outcomes: In the time period January 2011 through May 2013, the average door to needle time was 87.3 minutes across a sample size of 19 patients. In May of 2012 we started the performance initiative and by June of 2013 the education of the staff was complete. The period June 2013 to December 2013 demonstrated an average of 49.31 minutes across a sample size of 16 patients. The process improvement initiative produced a 43.5% improvement in door to needle time. The total costs of the performance improvement initiative were limited to staff meeting and training time. Implications: Our emergency department began 2012 with door to needle times of an average of 87 minutes, which is greater than the American Stroke Associations goal of sixty minutes. With the implementation of this performance improvement initiative, t-PA times in 2013 were reduced by 43.5%. A focused agenda of multidisciplinary education as well as stroke protocols provided notable improvements to our door to needle times for t-PA. Further refinement of these processes and a continued emphasis on staff education should continue to improve our door to needle times of t-PA in acute ischemic stroke patients.
Keywords:
Door to Needle Time; Acute Ischemic Stroke Patients
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.titleReducing Door to Needle Times in Acute Ischemic Stroke Patientsen_GB
dc.contributor.authorJones, Beverlyen_GB
dc.contributor.authorBodine, Jenniferen_GB
dc.contributor.authorMcKinness, Angelen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsBeverly Jones, DNP, ACNP, CCRN, bjonesnp13@gmail.com; Jennifer Bodine, MHA, MSN, RN, CEN; Angel McKinness, MSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344160-
dc.description.abstractEvidence-based Practice Abstract Purpose: Intravenous plasminogen activator (t-PA) is an accepted and proven intervention in patients with acute ischemic stroke. The benefits of t-PA in acute ischemic stroke are time dependent and current guidelines recommend a door to needle time of less than 60 minutes. Despite the strong evidence and recommendations, recent studies indicate that less than one third of patients are given intravenous plasminogen activator or t-PA within the sixty-minute window. The clinical process is complex and involves many different clinical departments to work together to achieve this goal. The Target: Stroke Initiative was used as the foundation for this performance improvement initiative. Our goal was to design a process for our emergency department that would improve door to needle times in acute ischemic stroke patients. Design: Performance Improvement Initiative. Setting: 44 bed urban emergency department with an annual volume of 45,000 patients. Participants/Subjects: Emergency department physicians, Neurologists, Radiologists, Nursing staff, Laboratory staff, Pharmacists. Methods: Utilizing a FOCUS-PDCA framework the performance improvement project was developed to analyze performance measures and identify barriers to meeting the door to needle time of sixty minutes. A number of processes were put in place. One involved implementing a Code Stroke Policy to establish guidelines for healthcare providers to rapidly identify and initiate treatment for patients experiencing symptoms of acute stroke. A second involved educational sessions for physicians as well as nursing staff to identify treatment of patients with t-PA. A third initiative included implementation of an annual t-PA skills check off required for the emergency department staff, medical response team and select Intensive Care Unit nurses to apply the knowledge taught. Weekly debriefing sessions with the multidisciplinary stroke team identified barriers to t-PA compliance and administration within 60 minutes. Results/Outcomes: In the time period January 2011 through May 2013, the average door to needle time was 87.3 minutes across a sample size of 19 patients. In May of 2012 we started the performance initiative and by June of 2013 the education of the staff was complete. The period June 2013 to December 2013 demonstrated an average of 49.31 minutes across a sample size of 16 patients. The process improvement initiative produced a 43.5% improvement in door to needle time. The total costs of the performance improvement initiative were limited to staff meeting and training time. Implications: Our emergency department began 2012 with door to needle times of an average of 87 minutes, which is greater than the American Stroke Associations goal of sixty minutes. With the implementation of this performance improvement initiative, t-PA times in 2013 were reduced by 43.5%. A focused agenda of multidisciplinary education as well as stroke protocols provided notable improvements to our door to needle times for t-PA. Further refinement of these processes and a continued emphasis on staff education should continue to improve our door to needle times of t-PA in acute ischemic stroke patients.en_GB
dc.subjectDoor to Needle Timeen_GB
dc.subjectAcute Ischemic Stroke Patientsen_GB
dc.date.available2015-02-04T11:27:34Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:34Z-
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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