Abstract TP452: Evaluation of Post Tissue Plasminogen Activator (tPA) Mobility Guideline Revisions: Focus on Education Process

Abstract

Background and Purpose: There is limited data regarding the safety of and nursing attitudes towards early mobilization of acute ischemic stroke (AIS) patients after thrombolysis. It is common to maintain patients on bedrest for 24 hours post-IV tPA infusion, delaying time to rehabilitation assessment, which may increase length of stay. There is considerable variability in protocols regarding mobilization of stroke patients among US hospitals. The purpose of this project was to assess the current attitudes of nursing staff regarding mobilization of post-thrombolysis patients and to assess the safety of early mobilization of AIS patients post-thrombolysis. Methods: A literature search and review of other benchmark institutions’ protocols was conducted. A change to post-thrombolysis order sets was made, stratifying timeframes for early mobilization based on NIHSS and treatment provided. A survey of the nursing staff (n=30) was conducted prior to the implementation of mobility order set changes, to assess comfort level with post tPA mobility guideline revisions and understanding of the actions of tPA. Education was provided to staff. A follow up survey (n=22) was conducted 3 months after order set implementation. Results: In a survey of other stroke programs (n=17), 59% indicated they had a bedrest protocol while 41% did not. Of the respondents, 52.9% required PT/OT evaluation prior to mobilization. On the internal pre- education survey, 14% of the nursing staff correctly identified the duration of action of tPA, with an increase to 45% on the post- education survey. On the pre- education survey, 75% of respondents indicated they would be comfortable mobilizing patients prior to 24 hours post-thrombolysis, with an increase to 95% on the post -education survey. Initially, 23% responded they would not be comfortable mobilizing patients prior to assessment by PT/OT, which decreased to 9% on the post- education survey. Conclusions: The early mobilization guidelines for the post tPA patient can be safely instituted using a stratification based on NIHSS severity. This may result in earlier rehabilitation assessment times and decrease lengths of stay.