T-13
Role of the Clinical Pharmacist in Reducing Decision-to-Needle tPa
Times During Code Stroke in the Emergency Department
Authors: Kevin Brandon RPh, Clinical Pharmacist; Amanda Kramer RN, BSN-Emergency Department Clinical
Advisor; Catherine Mulawka RN, MBA, Stroke Coordinator & Clinical Projects Advisor
Background:
 Clinical observation revealed inconsistent ED decision-to-needle tPa times due to differing
processes including pharmacist mixing in the central pharmacy, ED RN mixing at the bedside, and
holding the tPa vial for stroke neurologist to mix upon arrival at the bedside
Purpose:
 Implement a consistent process for tPa calculation and mixing
 Reduce decision-to-needle times, increasing the opportunity for successful patient outcome
Method:
 Conduct retrospective chart review to establish baseline tPa decision-to-needle times in the ED
 Review current process of calculating, mixing, and administering tPa
 Identify areas for process streamlining and reducing potential for error by calculating and mixing tPa at
the bedside
 Established goal of zero minute decision-to-needle time
 Clinical Pharmacist added to Code Stroke pager team in May 2010
 Initial Clinical Pharmacist role consisted of dose calculation and verification with ED nurse at bedside
 Expanded Clinical Pharmacist role to include mixing tPa at beside in conjunction with nurse, while
maintaining compliance with USP 797 Guidelines*
 Implement process of bedside conference between Clinical Pharmacist and ED RN to identify eligible
candidates, allowing the Clinical Pharmacist to prepare tPa in preparation of anticipated administration
 Clinical Pharmacist’s role progressed to include immediate bedside medication education to patient
and/or family, including verbal and written education materials
Results:
 Addition of Clinical Pharmacist to Code Stroke team, with responsibility of calculating and
mixing tPa at the bedside, has resulted in improved zero minute decision-to-needle times.
 2010: zero minute decision-to-needle time not achieved
 2011: zero minute decision-to-needle achieved in 60% of administrations
 2012: (through July): zero minute decision-to-needle achieved in 78% of administrations
Conclusion:
 Addition of a Clinical Pharmacist to the Code Stroke team resulted in a reduction of decision-toneedle tPa times in the Emergency Department
Implications for Practice:
 Utilization of Clinical Pharmacist during Code Stroke to calculate and mix tPa reduces decision-toneedle time
* http://www.emlab.com/s/services/USP_797.html