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BackgroundThe timely evaluation and initiation of treatment for acute ischemic stroke (AIS) is critical to optimal patient outcomes. However, clinical practice often falls short of guideline-established goals. Hospitals in rural regions of the USA, and notably those in the Stroke Belt, are particularly challenged to meet timing goals since the vast majority of primary stroke centers (PSCs) are concentrated in urban academic institutions.MethodsBetween May 2015 and May 2017, emergency department (ED) teams from 5 non-PSC hospitals in the Stroke Belt participated in a quality improvement (QI) initiative. The intervention included a baseline practice assessment survey, repeat audit-and-feedback cycles with patient data on AIS treatment timing, personalized Continuing Medical Education/Continuing Education-certified grand rounds sessions at each participating site with expert study faculty, targeted reinforcement of best practices, and follow-up to evaluate the benefits and limitations of the intervention.ResultsAt the start of the initiative, clinical staff from participating EDs overestimated the proportion of patients with AIS who received alteplase within the guideline-recommended 60-minute door-to-needle window at their facility. At the end of the 6-month intervention period, significantly more patients were treated with alteplase within 60 minutes of ED arrival compared to baseline across the entire sample (1.9% of patients at baseline vs. 5.2% at 6 months; P < 0.01). Similarly, there was a trend toward a decrease in the percentage of patients whose alteplase treatment was initiated more than 60 minutes after their arrival at the ED (67.3% at baseline vs. 22.2% at 6 months).ConclusionStructured QI interventions that engage ED care teams to reflect on processes related to AIS diagnosis and treatment and deploy repeat audit-and-feedback cycles with real-time patient data have the potential to support an increase in the number of patients who receive alteplase within the guideline-recommended timeframe of 60 minutes from hospital arrival.

PI CME provides insight into and aids in improving evidence-based patient care in psychiatric practices.

Background: Many community-dwelling adults do not adhere to their medication regimen, which results in high rates of emergency department visits and subsequent hospital admissions. Occupational therapists, as members of the home health care team, provide medication management in the occupational therapy scope of practice. There is sparse information in the literature regarding occupational therapists' involvement in medication management in home health care practice.Methods: The researchers interviewed nine occupational therapists practicing in home health care. Using a qualitative interpretive phenomenological study, the researchers explored the participants' experiences addressing medication management.Results: The researchers identified three themes: professional reasoning, interprofessional involvement, and professional competence and confidence. The participants reported that they were addressing medication management in accordance with occupational therapy scope of practice; however, they did not feel confident because of their lack of knowledge about pharmacology.Conclusion: Preparing entry-level occupational therapy students and practicing occupational therapists with interprofessional education about medication management will improve occupational therapists' competence and confidence. Occupational therapists who know their role in medication management and are well-informed about medication can collaborate with the home health care team more effectively. CommentsThe authors report no conflicts of interest to disclose.

Date Presented 04/04/19 Exploring and understanding OTs’ experiences of working with home healthcare clients to manage their medication will provide useful information to develop appropriate medication management guidelines and competency standards to improve overall OT in home healthcare practice. OTs who know their role in medication management and are well-informed about medication can collaborate with the home healthcare team more effectively. Primary Author and Speaker: Julie Blum Additional Authors and Speakers: Jennifer Fogo, Judith Malek-Ismail