Abstract TP392: Employing eICU Monitoring for Post-alteplase Sequencing Optimizing Outcomes

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Background and Purpose: Intravenous tissue plasminogen activator is the only Food and Drug Adminsitration-approved treatment for acute ischemic stroke. Post treatment is often monitored in an intensive care unit (ICU) with rigourous sequencing of vital signs and neurological examinations. Despite vigilant nursing assessments, post-activase intensive monitoring demonstrated gaps in capturing all frequencies required not only by Joint Commission requirements but medical industry and safety standards. Current research challenges the need for lengthy ICU monitoring post-thrombolytics.Methods: A retrospective chart review was performed on 118 patients who entered Providence Alaska Medical Center for an emergent stroke alert. Data was collected on stroke severity, risk factors and alteplase usage. A comparative analysis was performed to determine the missed sequences out of 36 total entries per patient, from 2014 without eICU monitoring to March of 2016 with eICU assistance.Results: With an average of 13% of patients recieving alteplase from a volume of 350 patients annually, 73% of those in ICU completed all 36 entries of post-treatment monitoring prior to the use of eICU collaboration in care. From January, 2015 to March 2016, 97% of the post-alteplase stroke patients recieved the complement of required sequencing.Conclusion: Despite recent studies indicating less intensive care is required post-alteplase administration, the use of eICU monitoring in this setting increases the complete complement of neurological and metabolic assessments as ordered. Proposals towards implementing telemedical monitoring in the advent of post-stroke care is useful.

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