Effect on door‐to‐needle recombinant tissue plasminogen activator administration times for acute ischemic stroke with and without an emergency department pharmacist

Abstract

Study Objective: A paucity of data exists on the impact emergency department (ED) pharmacists have on a stroke team's door-to-needle (DTN) administration time of recombinant tissue plasminogen activator (rTPA). The purpose of this study was to assess the odds of achieving a DTN administration time for rTPA of 60 minutes or less with an ED pharmacist present.Methods: This was a retrospective, cohort study of patients who received rTPA for acute ischemic stroke (AIS) from May 2017 to May 2018. Patients were included if they were at least 18 years old and received tPA for AIS in the ED. The primary outcome for this study was the likelihood of patients receiving a DTN administration time of 60 minutes or less with or without an ED pharmacist present during a stroke alert at a primary stroke center.Results: The electronic medical record of 184 stroke alert patients was reviewed, and 65 patients were included in the final analysis. Baseline characteristics were similar in all aspects.The odds ratio was 3.3 (95% confidence interval [CI]: 1.1-9.6; P = 0.04) to achieve a DTN administration time of 60 minutes or less when an ED pharmacist was present. The ED pharmacist present group had faster median (47 minutes vs 60 minutes; P = 0.001) and average (49 minutes vs 63 minutes; P = 0.003) DTN administration times compared with the ED pharmacist not present group.Conclusion: An ED pharmacists present during a stroke alert at our faculty resulted in reduced overall DTN rTPA administration times and increased the odds of a patient receiving rTPA less than 60 minutes from arrival for AIS. Further study is required to determine if this finding can be replicated in other EDs. K E Y W O R D Sclinical pharmacist, stroke, thrombolytic

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

“…[3][4][5] Similar to our study, in the Gilbert and colleagues study, the odds ratio of achieved DTN less than 60 minutes with a pharmacist present in the stroke team was three times more likely. 7 Contrasting to our study, in the Montgomery and colleagues (42% vs 19%) and Jacoby and colleagues studies (49% vs 25%), DTM was achieved in less than 45 minutes twice as often in the pharmacist vs nonpharmacist groups. 3,6 Unlike previous studies, there was no concurrent improvement phase; however, it is important to note that all stroke centers are constantly reviewing DTN and identifying areas for improvement.…”

“…During the "improve" 3). [3][4][5][6][7] In our study, reduction in DTN time (12 minutes) with pharmacist involvement in stroke teams was consistent with similar studies, with a reduction in DTN time ranging from 14 to 25 minutes (Table 3). [3][4][5][6][7] In the Gosser and colleagues (29.9% vs 15.8%), Montgomery and colleagues (71% vs 39%), and Rech and colleagues studies (71% vs 29%), DTN was achieved in less than 60 minutes twice as often in the pharmacist vs non-pharmacist groups.…”

“…[3][4][5][6][7] In our study, reduction in DTN time (12 minutes) with pharmacist involvement in stroke teams was consistent with similar studies, with a reduction in DTN time ranging from 14 to 25 minutes (Table 3). [3][4][5][6][7] In the Gosser and colleagues (29.9% vs 15.8%), Montgomery and colleagues (71% vs 39%), and Rech and colleagues studies (71% vs 29%), DTN was achieved in less than 60 minutes twice as often in the pharmacist vs non-pharmacist groups. [3][4][5] Similar to our study, in the Gilbert and colleagues study, the odds ratio of achieved DTN less than 60 minutes with a pharmacist present in the stroke team was three times more likely.…”

“… 3‐7 In the Gosser and colleagues (29.9% vs 15.8%), Montgomery and colleagues (71% vs 39%), and Rech and colleagues studies (71% vs 29%), DTN was achieved in less than 60 minutes twice as often in the pharmacist vs non‐pharmacist groups 3‐5 . Similar to our study, in the Gilbert and colleagues study, the odds ratio of achieved DTN less than 60 minutes with a pharmacist present in the stroke team was three times more likely 7 . Contrasting to our study, in the Montgomery and colleagues (42% vs 19%) and Jacoby and colleagues studies (49% vs 25%), DTM was achieved in less than 45 minutes twice as often in the pharmacist vs non‐pharmacist groups 3,6 .…”

“…7 CI, confidence interval; DTN, door-to-needle; OR, odds ratio; PharmD, doctor of pharmacy/clinical pharmacist.…”