Abstract 3771: Does Mixing T-pa At Bedside Improve DTN, Without Increasing The Risk Of Complications

• DOI: 10.1161/str.43.suppl_1.a3771
• Publication Date: 2022-03-20T05:10:32Z
• Authors: James P Lugtu; Debbie Camp; Nojan Valadi; Susan Zimmerman; Kim Anda; Trish Westbrook; Misty Burkhalter
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Background/issues: Acute Ischemic stroke is a time sensitive disease. The only approved treatment is t-PA. Prior studies have demonstrated faster Door-to-Needle (DTN) times for t-PA treated stroke patients were associated with fewer complications and lower risk adjusted mortality. In conjunction to these findings the American Stroke Association has adopted in 2011 the goal to decrease the door to needle time on all eligible patients. The Georgia Stroke Professional Alliance (GA-SPA) has continued to encourage its members to achieve Target:Stroke designation. In response to this challenge seven separate facilities were able to reach this goal. Of note each facility is unique in its geographical location, size, and setting. Despite these differences each was able to obtain the same result in meeting the Target:Stroke criteria. In an effort to reduce the DTN, some facilities have begun mixing t-PA at bedside, while others utilize central pharmacy.

Purpose: Identify the method utilized at each facility to mix t-PA. Determine if mixing at Bedside versus central pharmacy improves DTN times. Determine if mixing at bedside increases the risk of adverse affects such as sICH or increase length of stay.

Methods: Of the Seven Target:Stroke facilities six submitted data on all t-pa recipients from January 2010 to December 2010. Each facility identified where t-PA is mixed and by whom. Facilities also provided the number of complications resulting from t-PA. Complications included increased length of stay directly related to t-pa, and sICH with an increase of two or more on the National Institute of Health Stroke Scale.

Results: Two hundred seventeen ( 217) t-PA cases were reviewed. Four facilities mix t-PA in Pharmacy representing 115 cases with a total of three reported complications. Two facilities mix t-PA at bedside by a trained RN with a total of three reported complications. There was no statistically significant increase in complications by facilities mixing at bedside.

Conclusions: Complications did not increase when t-PA is mixed outside of pharmacy. Facilities can successfully attain Target:Stroke Designation, regardless of where t-pa is mixed. Further studies will be conducted to see if mixing at bedside decreases DTN time.