Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke

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

“…The median DTN administration times with a pharmacist present group was similar, at 47 minutes, compared with previously reported times of 46‐69.5 minutes . In the ED pharmacist not present group, times were similar to previous studies, with a median administration time of 60 minutes compared with 58‐89.5 minutes .…”

“…What remains to be seen is whether any clinical outcomes may be affected with the utilization of a pharmacist on the stroke team, which could be answered with larger randomized controlled trials designed to address these functional outcomes. This study adds to the paucity of literature which shows the association of having a pharmacist implemented into the stroke team and a reduction of DTN administration times, and with some data suggesting that faster administration of rTPA leads to better functional outcomes . What also remains to be addressed is the potential financial implications of adding a pharmacist into stroke teams.…”

“…Expedited administration of rTPA for AIS remains an ongoing quality improvement initiative for many stroke centers across the country. The utilization of pharmacists in stroke teams has been shown to improve overall DTN administration times, but this is one of the first studies to examine the impact pharmacist have on the guideline specific recommendation of a DTN administration time of less than 60 minutes . Reduction in overall administration times can prove controversial given that the “time is brain” concept is not universally endorsed in the medical community.…”

“…Previous literature have shown some of the beneficial impact that including an ED pharmacist into the stroke team can provide . Most of the literature with regard to pharmacist involvement in AIS have been with a reduction in DTN administration times and more accurate dosing of rTPA, without focusing on the overall goal metric of a DTN administration time of 60 minutes or less . Debate will continue as to whether faster administration of rTPA leads to better functional outcomes, but for now, the standard for stroke centers is rapid rTPA administration based on the AHA guideline of a DTN administration time of 60 minutes or less .…”

Comprehensive identification of medication‐related problems occurring prior to, during and after emergency department presentation: An Australian multicentre, prospective, observational study

“…As we were unable to conduct a home visit or face‐to‐face interview for patients discharged directly from ED, relying instead on telephone interviews, we may have under‐estimated the prevalence of MRPs. Although some authors have suggested roles for ED pharmacists in minimising time to administer critical medications, such as thrombolysis in stroke, our study did not include such delays as MRPs, because we were unable to systematically identify these delays, with our methodology. Similarly, our methodology has likely under‐estimated the prevalence of administration and dispensing errors, due to difficulties in identifying these errors after the ED presentation if they were not identified and documented during the presentation.…”