Abstract P29: Improving Door to Needle Alteplase Times: Pharmacist Involvement During Code Stroke

Abstract

Introduction: According to the American Stroke Association’s “Guidelines for Acute Ischemic Stroke (2018),” it is a Class IIb recommendation that hospitals set a goal of achieving Door to Needle (DTN) times within 45 minutes in > 50% of ischemic stroke patients who are treated with IV alteplase (tPA). Furthermore, a new Class I recommendation states that “multidisciplinary teams with access to neurological expertise [be utilized] to safely increase IV thrombolytic treatment.” Review of the literature shows that there is still limited research in this area, and the potential exists to discover more about the utility of the pharmacist role in the acute stroke patient. Methods: A retrospective, single-center study of patients who received alteplase for acute ischemic stroke in the Emergency Department, based on the initial “Code Stroke” activation, between January 1, 2019 and July 1, 2020 was conducted. The purpose was to investigate the difference in DTN treatment times when a pharmacist is involved compared with times when a pharmacist is not available. The primary outcome was the median DTN administration time, with secondary outcome of achievement of DTN time < 45 minutes. Results: The patients who had a pharmacist involved in their care (n=30) showed a median DTN time of 42.5 minutes, compared to 58 minutes in the group without pharmacy involvement (n=22). Patients in the pharmacy group achieved a DTN time of < 45 minutes in 57% of cases, versus 32% of cases in the non-pharmacy group. Conclusion: Our current practice in the ED regarding availability of a pharmacist varies, given variable patient volume and limitation of resources in our community-based, Primary Stroke Center. Our data suggests that expanding the number of hours covered by a dedicated pharmacist might help improve DTN times. Though our standard practice is still to provide scheduled, regular training on alteplase to ED nursing staff, the unique expertise and additional benefits provided by a pharmacist may serve to complement and enhance the treatment effectiveness of the entire team.