Abstract TMP46: Barriers and Facilitators to Tenecteplase Implementation: A Mixed-Methods Study

Abstract

Introduction: Tenecteplase (TNK) has potential advantages over alteplase for treating acute ischemic stroke (AIS). Yet, TNK adoption is not universal. This mixed-methods study identifies common barriers and facilitators to TNK implementation. Methods: We surveyed 40 Texas hospitals using qualitative interview and a Likert questionnaire. Hospitals ranged from Acute Stroke Ready Hospitals that had not implemented TNK to Comprehensive Stroke Centers using TNK. Qualitative themes were identified using a phenomenological approach with hermeneutic cycling. Quantitative data were examined using SAS v9.4. Results: Thematic analysis identified 3 themes (Evidence, Process flow, and Consensus) and 8 sub-themes which were mapped to barriers and facilitators identified through quantitative analysis (Table 1). Hospitals that implemented TNK differed significantly from non-adopters in their perceptions of barriers related to clinical evidence, TNK delivery times, and legal issues (P<.05). However, both groups shared similar views on key barriers of having a TNK policy, buy-in from administration, TNK cost, and pharmacy approval ( P >.05). Conclusion: The study provides insight into the barriers and facilitators perceived by stroke clinicians when implementing TNK for AIS patients. The results provide a foundation for developing an implementation science study to facilitate successful TNK implementation via a TNK Toolkit to assist with known barriers by leveraging identified facilitators. The toolkit will be validated in a future prospective interventional block randomized study.