Abstract WP384: The Impact of a Clinical Pharmacist on Door to Needle Time


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Abstract

Background and Issues: Decreasing thrombolytic door-to-needle (DTN) time has been shown to improve neurological outcomes of ischemic stroke patients as well as decrease incidence of bleeding. At Aultman, a dedicated pharmacist responds to all stroke alerts between 0700 and 1700 Monday through Friday. In September of 2014, a clinical pharmacist was added to the stroke team to attend stroke alerts and focus solely on facilitating the TPA ordering, dispensing, and delivery, with the goal of decreasing DTN times. The mixing of the tPA was done in the central pharmacy during all alerts. At the same time of hiring a clinical pharmacist, Aultman changed the stroke alert procedure to immediately send patients straight to CT after an alert was called.Purpose: To compare DTN times with and without the presence of a pharmacist on emergency department stroke alerts.Methods: For all stroke cases where tPA was administered from January 1 2014 to July 31 2016, the DTN was grouped based on pharmacist presence - before a pharmacist was present on any stroke alerts (January 1 2014 to September 30 2014), when a pharmacist was present, and when a pharmacist was not present after September 30 2014. A Shapiro-Wilk analysis was run to assess normality, and the Mann-Whitney U test was used to compare the means.Results: From January 2014 to the placement of a pharmacist on the stroke team, the mean DTN time was 80.68 minutes (95% CI: 62.23-99.14 min, n=19). After hiring a pharmacist (September 2014 to July 2016), the mean DTN time was significantly different (p=0.001) when a pharmacist responded to stroke alerts (48.26 minutes, 95% CI: 38.11-58.40 min, n=27) compared to when a pharmacist was not present (68.63 minutes, 95% CI: 59.57-80.69 min, n=31).Conclusion: Having a pharmacist who can focus solely on the tPA portion of a stroke alert can significantly decrease DTN times. The pharmacist knows the computer ordering system more fluently than the provider increasing ordering speed and can allow other members of the stroke team to focus on their responsibilities during the alert. The decrease in DTN time from early 2014 to post-September 2014 when a pharmacist was not present could be attributed to implementation of new policies routing stroke alerts directly to CT.

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