Abstract WP391: Time out Process Prior to Administration of Tissue Plasminogen Activator for Acute Ischemic Stroke Treatment
The goal to administer tissue plasminogen activator within 60 minutes of patient arrival to the Emergency Department is attainable through rigorous attention to a standardized process and interdisciplinary collaboration.
This pilot sought to enhance safety and improve reliability of administration for tissue plasminogen activator with implementation of a time out prior to administration.
An interdisciplinary team designed an improvement strategy related to the process reliability of tissue plasminogen activator administration. Four errors occurred in 12 months, a failure rate of 10¯1 (failure of 1 in 10 administrations). Primary goal: design a process with a failure rate of <10¯3 (failure of 1 in 1000 administrations). Secondary goal: ensure alignment with current work flow associated with bar code medication administration. The concept of a safety time out was adopted with 7 confirmatory elements: time last known well, blood glucose, anticoagulation status, blood pressure, contraindications, team consensus, and assurance of a patent intravenous catheter. The Informatics team designed a tool within the electronic health record. A standardized communication process was written. Participants in the time out included a physician and nurse at the patient’s bedside. All stakeholders received training. Prior to redesign, there was a failure rate of 10¯1 with confirmation of all safety elements in 88% of tissue plasminogen activator recipients. The time out procedure was trialed in 5 patients with 100% compliance and an extrapolated failure rate of 10¯3. The average door to needle time was 60 minutes versus 69 minutes prior to the pilot. The time out process took less than 1 minute in all cases. In this group, the time-out successfully identified a missing element - a blood glucose result - the process was stopped until the result was available.
The redesigned process is safe. There was no negative impact to achieving the standard of care. The primary goal of 10¯3 performance was achieved. Secondary goal: alignment with current medication administration process achieved. Unanticipated results: decrease door to needle time and greater satisfaction with a collaborative approach to medication administration.
Author Disclosures: C. Spahr: None. R. Linde: None. S. McKniff: None. J. Deel: None. J. Mingle: None.
- © 2016 by American Heart Association, Inc.