Background: IV tPA is the only drug approved for the initial treatment of acute ischemic stroke, and can only be given within 3-4.5 hours from stroke symptom onset. Studies demonstrate that for every 15-minute reduction in door to needle time (DTN) there is a 5% lower odds of mortality. The faster tPA is administered, the better the patient’s chance for a meaningful recovery.
Purpose: As part of an ongoing initiative to decrease DTN times, we applied the concept of “mobile mixing” to our stroke alert process. Typically, tPA is mixed in the main pharmacy and delivered to the CT scanner, which occasionally resulted in a delay in care. The mobile mixing process gives the pharmacist the resources necessary to compound tPA for immediate use while the patient is still in CT.
Methods: We began work on this quality improvement project in August 2015. Our multidisciplinary team, consisting of advanced practice providers, pharmacists, nurses, and our stroke medical director, met monthly to design and evaluate our pilot process. Pharmacy created tackle boxes containing the medications and supplies required to mix and administer tPA. We addressed staffing challenges, held mock stroke alerts; collected data on response times for a six-week period, and evaluated the impact this intervention made on our times.
Results: During the pilot period, we treated 10 patients with tPA with a median DTN of 23.5 minutes. Further, as of July 2016, we gave tPA 60 times with a pharmacist present with a median DTN of 23.5 minutes. This has translated into a 2016 year-to-date DTN of 23.5 minutes. Members of the stroke team acknowledge that this process has also contributed to an increased sense of patient safety and team collaboration.
Conclusions: The mobile mixing project has had a direct positive impact on patient care. The faster we give tPA, the faster the patient is then ready for the angiography suite if he or she is candidate for mechanical thrombectomy. In stroke, every minute counts and the mobile mixing project is one piece of the well-oiled machine that achieves a positive outcome for patients every day.