Abstract 2191: A Multidiciplinary Team Approach To Improving The Quality Of Care In The Setting Of Tissue Plasminogen Activator
Background and Purpose: Monitoring of vital signs and neurolgic status is imperative after thrombolytic therapy to prevent complications but can be difficult to document in real time. We sought to improve the documentation of vital signs and neurologic evaluations during and after t-PA.
Methods: We retrospectively audited all acute ischemic strokes receiving t-PA March through June 2010. A total of 12 patients received t-PA. The average age was 68.4 years with 48% of this population being male. These patients did not have adequate and consistent vital sign and neurologic check documentation. Of the 12 patients receiving t-PA, only 27.5% of patients had proper documentation as defined by the NINDS. In June and July 2010, the stroke team held 7 meetings with the nursing staff, ED, Neuro ICU, pharmacy and physicians to gather ideas for methods to improve compliance. An aggressive education endeavor was developed with nursing, physicians and pharmacy staff. The stroke team reinforced and re-educated staff regarding the standard order sets, stroke competencies and stroke guidelines. The nursing staff developed signage to place above the patient’s bed when receiving t-PA, to remind the staff of the required time frames for documentation. The ED staff created a reminder ticket/ flyer that the pharmacist carries in the t-PA administration box to hand to the nurse when t-PA is about to be administered. We moved the vital sign frequency from the second page to the front page of the standard t-PA administration order set.
Result: Between July 2010 and February 2011, we gave t-PA to 39 patients, of whom the average age was 61.0 years with 47.4% of this population being male. Utilizing all of the methods and extraordinary collaboration, 91% were fully compliant for neurologic checks and vitals signs during and following t-PA administration.
Conclusion: We conclude that ongoing education and reinforement is effective for promoting change in adherence to documentation guidelines after thrombolytic therapy. When we have the occasional fallout, we reach out to that area immediately to talk with and educate the staff to determine the cause and most importantly what we can do to prevent this. Working together has greatly improved documentation compliance.
- © 2012 by American Heart Association, Inc.