The Impact of Nursing to Achieve Door-to-Drug Times of ≤ 45 Minutes in Acute Ischemic Stroke
Background: Nursing care in a large urban university affiliated Level 1 Trauma and Comprehensive Stroke Center faces a series of competing priorities. The goal of door-to-drug for alteplase in acute ischemic stroke is 60 minutes. As time is brain, every 15 minutes saved increases the odds of good functional outcome.
Objective: To evaluate the impact of alteplase reconstitution by nurses at the bedside in the Emergency Department (ED) on door to drug times compared with traditional pharmacy reconstitution process.
Methods: A retrospective quality improvement project evaluating all stroke patients treated with alteplase at our institution from October 2016 - June 2017 was completed yielding 60 patients. Door-to-drug times using traditional pharmacy reconstitution from October 2016 to January 2017 (n=32) was compared to nursing reconstitution from February 2017 to June 2017 (n=28). The proportion of patients with door-to-drug times of ≤ 45 minutes in both groups was evaluated. T-test for independent means for time differences and Chi-square test of proportions was used to calculate the statistical significance in time reduction between both patient cohorts.
Results: As compared to pharmacy reconstitution, the mean door-to-drug times for nursing was 15 minutes shorter with nursing (50.75 +/-21.2 vs. 65.9 +/-29.8 minutes) (p=0.029). The proportion of patients within the 45 minute time window in the nursing cohort was more than double that with the pharmacy (60% [n=17] vs. 27.8% [n=7], p=0.02). Furthermore, there were no reported dosing errors in either group.
Conclusions: In our study, nursing reconstitution at the bedside reduced door-to-drug times by 15 minutes and doubled the proportion of patients receiving alteplase within the 45 minute mark. Eliminating treatment delays for patients with acute ischemic stroke lowers in-hospital mortality and reduces long term disability. Efficient nursing reconstitution directly impacts the patient’s door to drug time which contributes to their functional outcome by providing a better chance for a disability-free life.