[Expert Solution]: Scenario Two: Ischemic Stroke Drug Change…

Scenario Two: Ischemic Stroke Drug Change in Emergency Room PDSA The emergency room (ER) wants to move from using alteplase (t-PA), the gold standard in ischemic stroke treatment since 1995, to the latest FDA-approved drug for ischemic strokes caused by clots, tenecteplase. The goal is to move to tenecteplase in 90 days smoothly with no dosing errors. This new drug has half as many serious complications involving brain bleeding. Additionally, because the medication is administered in a single dose bolus over five seconds, administration is easier as opposed to t-PA, which is administered over one hour. If transport is needed, the transfer itself is more efficient because the tenecteplase strategy is “give and go” instead of “drip and ship” with t-PA. Due to the rapid administration, the potential for saving brain tissue is greatly increased. Plan: The interdisciplinary team of ER physicians, nurses, pharmacists, radiologists, radiology technologists, rapid response team members, critical care physicians, and neurology physicians developed a process to safely transition to tenecteplase through extensive training. The main process consideration is appropriate dosing and establishing a new standard operating procedure. As part of this procedure, pharmacists were designated to fill and maintain each stroke box. The procedure was designed to allow for dosing to be determined by the neurologist. Do: After multiple meetings and communications, the new stroke boxes were deployed for treating patients. Study: Within the first month, four patients were treated successfully. No dosing errors occurred, and the results are promising. When each patient was stabilized, an after-action debriefing or “hot wash” was conducted. Some of the issues that were noted included nursing having difficulty engaging neurology in a timely manner to determine dosing, but stroke pharmacists were readily available at each rapid response with dosing recommendations. Additionally, patient flow was slowed down as the current system for activating a Code Stroke requires separate calls to neurologists and radiology. Finally, in one case, triage was delayed related to a new to the ER admissions registrar. Act: While a safe transition has occurred to tenecteplase without dosing errors, improvement in response time is needed.