Impact of clinical pharmacist participation in stroke team activations on tissue plasminogen activator door‐to‐needle time

Abstract

INTRODUCTION: Current stroke guidelines recommend that treatment with tissue plasminogen activator (tPA) should be initiated as quickly as possible in eligible patients to provide maximum therapeutic benefit. Pharmacists possess multiple skills including knowledge of dosing, reconstitution, and improved access to medication that may positively impact door-to-needle (DTN) times for patients with acute ischemic stroke. OBJECTIVE: The objective was to evaluate the impact of a clinical pharmacist on time to tPA administration in patients with acute ischemic stroke. METHODS: This was a retrospective, single-center cohort study at a community teaching hospital and certified primary stroke center from January 1, 2014 to December 31, 2018. The primary outcome of this study was to compare the average DTN time with a pharmacist present at a stroke team activation vs no pharmacist present. Secondary outcomes included the proportion of patients in each group meeting a DTN time of less than 60 minutes and the proportion of patients in each group meeting a DTN time of less than 45 minutes. Statistical analysis utilized included Wilson's t-test to compare average DTN time and the odds ratio to determine a DTN time <60 or 45 minutes between the pharmacist and non-pharmacist groups.RESULTS: Pharmacist involvement was associated with a reduction in the average DTN time: 66 minutes vs 78 minutes (P = .038). The DTN time of less than 60 minutes was met in 60% of cases with a pharmacist present compared with 35% without a pharmacist (P = .005). The DTN time of less than 45 minutes was met in 18% of cases with a pharmacist present vs 20% without a pharmacist (P = .71).CONCLUSION: Pharmacist participation in stroke teams in the emergency department may reduce DTN times and increase the likelihood of a patient receiving tPA in less than 60 minutes.

Ideal Foundational Requirements for Stroke Program Development and Growth: A Scientific Statement From the American Heart Association

“…In addition, clinical pharmacists assist with medication prescribing, facilitate medication reconciliation and patient/ family knowledge during care transitions, develop evidence-based protocols, and educate interprofessional stroke team members about prescribing choices and drug interactions. [44][45][46][47][48][49] Nursing Although registered nurses are essential to hospital services and the most prevalent hospital clinicians, they often receive minimal stroke education beyond initial orientation. Neurovascular nursing requires mastery of a unique body of knowledge and clinical skills to ensure delivery of evidence-based practice.…”

“…In addition, clinical pharmacists assist with medication prescribing, facilitate medication reconciliation and patient/family knowledge during care transitions, develop evidence-based protocols, and educate interprofessional stroke team members about prescribing choices and drug interactions. 44–49…”