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Abstract TMP87: Improving t-PA Assessment Compliance Using a Hand-Off Communication Tool

2013; Lippincott Williams & Wilkins; Volume: 44; Issue: suppl_1 Linguagem: Inglês

10.1161/str.44.suppl_1.atmp87

1524-4628

Jeanette Stebelton, Kelly Kozlowski, Laurie Neldberg-Weesen, Roman Politi,

Healthcare Systems and Practices

Background: Programs seeking Primary Stroke Center Certification (PSCC) must use a standardized method of delivering clinical care, based on the American Heart/American Stroke Association or equivalent evidenced-based guidelines. After reviewing the assessment activities following the administration of IV tissue plasminogen activator (t-PA), opportunities for improvement were noted. Marquette General Hospital is a 315 bed hospital in Michigan’s Northern Peninsula, and is the only PSC within a 180 mile radius. Objective: To improve our program’s processes and assessment activities to attain 100% compliance with t-PA administration clinical guidelines and documentation surrounding the same. Methods: A review of records was conducted from December 2011 to July 2012 on all ischemic stroke patients receiving t-PA either at our institution or though the drip and ship transfer method during this time frame. A total of 6 pre-intervention and 3 post-intervention records represented the total t-PA patient volume for this time period (n=9). Specific interventions were developed to improve compliance with t-PA clinical guidelines including: the identification of barriers preventing compliance with assessment activities, obstacles preventing import of vitals to Electronic Medical Record (EMR), development of a standardized process for hand-off communication regarding frequency of vitals and neurological assessments, and a review process to assess correlation of missed assessment activities with patient outcomes. Results: Within 3 months after implementation of the process changes, adherence for vitals went from 85% to 95%. Adherence for neurological assessment went from 72% to 90%. Conclusion: These interventions were associated with an increase in the program’s assessment activities that are consistent with clinical practice guidelines, suggesting that the development of a standardized process for hand-off communication regarding frequency of vitals and neurological assessments was of benefit to compliance. Further research is needed to evaluate patient outcomes associated with inter-hospital post t-PA transfer and patient assessment nursing protocols.