Kin Chan, Pharm.D., BCPS
Clinical Emergency Medicine Pharmacist
Kettering Medical Center, United States
Disclosure information not submitted.
Elizabeth Jacob, Pharm.D., BCPS
Residency Program Director
Kettering Medical Center, United States
Disclosure information not submitted.
Aleda Chen, Pharm.D., M.S., Ph.D.
Statistician
Cedarville University, United States
Disclosure information not submitted.
Title: The Impact of Pharmacist Presence in tPA Administration Timing in the Emergency Department
Introduction: Studies have demonstrated the importance of rapid administration of thrombolytic agents for acute ischemic stroke patients. Faster reperfusion of the brain after infarction results in improved long term neurologic outcomes 3-5. Several studies have shown that the presence of a pharmacist at the bedside improve logistical outcomes related to the administration of tPA in the emergency department (ED)6,7. However, pharmacists are not staffed in the ED in all hospitals 24 hours each day to assist the team in clinical decision making, dosing and administration of tPA. The purpose of this study is to determine if the presence and assistance of a pharmacist in the coordination and administration of tPA improves door-to-needle time in the ED.
Methods: This study is a retrospective chart review of patients who received tPA within the ED. Patients were stratified into two groups: treatment team with and without a pharmacist. The primary outcome assessed if a door-to-needle time goal of less than or equal to 60 minutes was attained. Secondary outcomes aimed to assess specific pharmacist impact regarding adherence to inclusion and exclusion criteria for use of tPA as well as identify risk factors associated with door-to-needle times outside of 60 minutes.
Results: 133 patients met inclusion criteria, 53 patients were included in the pharmacist present arm and 80 patients were included in the pharmacist absent arm. There was no significant difference in the incidence of door-to-needle time less than 60 minutes between the groups. However, the pharmacist present group had a shorter door-to-needle time compared to the no-pharmacist arm (56.25 minutes vs 66. 99 minutes, p=0.018). Identified risks for prolonged door-to-needle times outside of 60 minutes include the need for antihypertensive agents prior to tPA initiation (68% vs 32%, p=0.011) and ambulatory arrival to the ED (67% vs 33%, p=0.034).
Conclusions: Pharmacists participating in the care of acute ischemic stroke patients who are receiving tPA have a shorter door-to-needle time compared to patients without a pharmacist present. Ambulatory arrival of patients presenting with acute ischemic stroke symptoms and the need for antihypertensive medications prior to initiation of tPA are associated with an increased risk of door-to-needle times outside of 60 minutes.