Mentor/s
*
Participation Type
Poster
Abstract
Introduction: Stroke is a prevalent acute illness in our society that can cause life-long debilitating deficits and in some cases can be fatal. The administration of recumbent tissue plasminogen activator, also known as Alteplase, is associated with better long-term outcomes, lower mortality rates, and decreased deficits when given rapidly following diagnosis. We aim to decrease the time from patient arrival to Alteplase administration in a small, rural emergency department in Pennsylvania by identifying delays and creating a workflow allowing for seamless identification and treatment of acute ischemic stroke. Methods: Areas of delays were identified following in-unit observation and an extensive literature search. An improved workflow was created and implemented along with a standing order set allowing the patient to obtain CT scan prior to being placed in a room. Findings: On a single patient walk through of the revised workflow the door to stroke alert time, door to CT scan time, and door to Patronus Neurology tele-consult times were all decreased from the previous quarter’s average. Discussion: Through implementation of a nurse-driven stroke alert protocol the triage nurse was empowered to identify a stroke, call a level one stroke alert, and facilitate the CT scan process all independent of physician guidance. Implications: By reducing these time spans and receiving Alteplase administration in a timely fashion, patients will appreciate better long-term outcomes and fewer deficits.
Key Words: stroke, alteplase, tPA, ischemic, thrombolytic, door-to-needle, DNT, CT scan, workflow, standing order set
College and Major available
Nursing MSN (online)
Location
Digital Commons
Start Day/Time
5-5-2021 1:00 PM
End Day/Time
5-5-2021 4:00 PM
Capstone Paper
Workflow of Stroke Patients Arriving by Personal Vehicle
Digital Commons
Introduction: Stroke is a prevalent acute illness in our society that can cause life-long debilitating deficits and in some cases can be fatal. The administration of recumbent tissue plasminogen activator, also known as Alteplase, is associated with better long-term outcomes, lower mortality rates, and decreased deficits when given rapidly following diagnosis. We aim to decrease the time from patient arrival to Alteplase administration in a small, rural emergency department in Pennsylvania by identifying delays and creating a workflow allowing for seamless identification and treatment of acute ischemic stroke. Methods: Areas of delays were identified following in-unit observation and an extensive literature search. An improved workflow was created and implemented along with a standing order set allowing the patient to obtain CT scan prior to being placed in a room. Findings: On a single patient walk through of the revised workflow the door to stroke alert time, door to CT scan time, and door to Patronus Neurology tele-consult times were all decreased from the previous quarter’s average. Discussion: Through implementation of a nurse-driven stroke alert protocol the triage nurse was empowered to identify a stroke, call a level one stroke alert, and facilitate the CT scan process all independent of physician guidance. Implications: By reducing these time spans and receiving Alteplase administration in a timely fashion, patients will appreciate better long-term outcomes and fewer deficits.
Key Words: stroke, alteplase, tPA, ischemic, thrombolytic, door-to-needle, DNT, CT scan, workflow, standing order set
Students' Information
Bethany Costello, BSN, RN, CCRN, Capstone: Evidenced Based Practice Project for Masters in Nursing: Clinical Nurse Leader.