Abstract T P264: Start the Clock- Stop the Clot- Decreasing Door to tPA Times
Background and Purpose: A process improvement project was identified in 2012 by our hospital stroke committee surrounding timeliness of administering tPA to eligible patients. Stroke committee members came together to identify these barriers and develop a more efficient process of administering tPA. The purpose of this project was to decrease our door to needle times. Our average door to needle times for the previous two years was 77 minutes. Opportunities for improvement that were identified prior to implementation included decreasing turn around times for laboratory studies, delayed decision making by patient and/or family, and time needed to perform additional clinical tasks.
Methods: A door to needle performance improvement team was formed. They first reviewed past cases to determine reasons for delays and used performance improvement techniques to determine current and ideal states and gaps in the process. The team discovered that staff needed a single resource with all of the necessary policies and procedures they would need to administer tPA. A reference folder was created that included job cards for all members of the care team identifying their roles and duties; checklists with procedural steps; patient education materials; tPA precaution signs, and inclusion/exclusion criteria checklist. Several other strategies implemented included purchasing timers to remind staff of target times, having designated IV pumps for tPA use only, and partnering with the Laboratory to expedite results. The final step in our process was to educate the staff on this process change and provide feedback on successes and opportunities for improvement.
Results: For the most recent year 7/1/2012-6/30/2013- 10 out of 11 (90.9%) patients receiving tPA did so within 60 minutes.
Conclusions: By implementing this targeted approach to administering tPA in less than 60 minutes, we have achieved for the third time in a row, the Target Stroke Award through Get with the Guidelines/American Heart Association. Within our health system, we are the only facility that has achieved this goal.
Author Disclosures: C. Deitch: None. J. Cummins: None.
- © 2014 by American Heart Association, Inc.