Door-to-needle magic
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Arika Witzerman, BSN, RN; Rhodora Tumamak, BSN, RN, MICN; Sanja Ryan, BSN, RN, PHN, MICN; David Miller, MHA, MSN, RN, NE-BC
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- Non-member
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Purpose: Research shows that infusion of TPA within 60 minutes of arrival during a stroke in evolution remarkably improves the patient's ability to regain motor/sensory functions to that prior to having the occlusive stroke. Quickly identifying the stroke patient and rapidly obtaining the radiologic data for diagnosis is key in inusing TPA.
Design: This project is an evidenced based quality project.
Setting: Metropolitan Community Primary Care Stroke/Comprehensive Emergency Department.
Participants/Subjects: All subjects are patients of either sex presenting to the emergency department with signs/symptoms of stroke during the month of October 2017. All ED staff participated in this project.
Methods: When a patient presents to triage, or we are notified by EMS that the are brining a patient with positive signs of stroke, the patient is quickly assessed using the NIHSS stoke scale tool to determine activation of "code stroke". The patient is immediatly placed on an ED cart, on arrival, dedicated for code strokes in order to obtain an acccurate wieight. Time of arrival is used to begin measuring door to needle time stamp in the EMR. Once activated an overhead announcement is made over the entire hospital alerting team members to repsond to the emergency department for assessment and intervention. This includes ED staff (ED Physician, Nurses, Tech's), ICU Neuro Intesivist, Pharmacist, Radiology Technician 24/7, When the announcement is made, one of the CT Scanners is cleared for immediate scanning capabilities. Once determined stable the patient is taken from ED to CT, along with ED RN, Neuro Intensivist and pharmacist. The neuro intensivist along with the radiologist make the diagnosis of occlusive stroke. If postive the TPA infusion begins in the CT scanner. The national benchmark for best outcomes regarding door to needle, by the American Heart Association is sixty (60) minutes. The EMR is the tool used for data retrieval for times in this project.
Results/Outcomes: During the month of October 2017 we had a total of fifty-eight (58) Code Strokes of which seven (7) met criteria for TPA. The average time of door to needle was thirty-five (35) minutes with the best door to needle time at fourteen (14) minutes.
Implications: An organized, multi-disciplinary team repsonse that is evidenced based and consistent allows stroke patients the best opportunity to not only resolve, but reverse stroke symptoms. Additionally, returns the patient to the best quality of life possible given current knowledge.
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | Quality Improvement |
Research Approach | Translational Research/Evidence-based Practice |
Keywords | LCM2018; Needle Magic; TPA |
Name | Emergency Nursing 2018 |
Host | Emergency Nurses Association |
Location | Pittsburgh, Pennsylvania, USA |
Date | 2018 |
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