Abstract Body: Background and Issue: The rural, critical access emergency department (ED) team was not consistently meeting the door-to-needle goal of 45 minutes for alteplase administration to acute stroke patients. The team’s process was ineffective in preparing for alteplase administration, resulting in delays in the administration of the thrombolytic.
Purpose: The quality improvement project aimed to create a new, consistent process to administer alteplase to acute stroke patients promptly.
Methods: There was a delay in acute stroke patients receiving alteplase after arrival to the rural, critical access ED. All stroke activations were reviewed as per the program’s guidelines. During the review, specific patterns were identified as barriers to meeting the program’s goals. It was noted that staff were accessing the automated medication cabinet multiple times for medications. The staff would retrieve the alteplase from the cabinet after the order was entered into the electronic medical record and then return to the cabinet to remove antihypertensives to treat the patient’s blood pressure before the alteplase administration. The action plan focused on creating a new process of establishing a virtual alteplase kit, which included two antihypertensive medications, in the automated medication cabinet. A stroke team member would retrieve the alteplase kit from the automated medication cabinet when the stroke activation was announced. While the patient was receiving the computed tomography exam, the team mixed the alteplase and prepared it for administration. Upon returning to the ED, the team obtained the patient’s weight and anticipated the alteplase order. Once the order was submitted by the physician and verified by the pharmacist, the team proceeded to administer the appropriate dose of alteplase.
Results: Developing the virtual kit and the consistent process of retrieving the kit and early mixing of the alteplase in stroke activations, led to the team meeting the goal for alteplase administration. Before implementing the new process, the team met the alteplase door-to-needle goal 40% in one year. With the implementation of the consistent process and the virtual kit, the team met the door-to-needle goal 67% in less than a year.
Conclusion: Implementing a standardized process in the rural, critical access emergency department decreased the door-to-needle time of the administration of alteplase, provided streamlined patient care, and improved patient outcomes.