Background
Intravenous (IV) tissue plasminogen activator (tPA) utilization in acute ischemic
stroke (AIS) requires weight-based dosing and a standardized infusion rate. In our
regional network, we have tried to minimize tPA dosing errors. We describe the frequency
and types of tPA administration errors made in our comprehensive stroke center (CSC)
and at community hospitals (CHs) prior to transfer.
Methods
Using our stroke quality database, we extracted clinical and pharmacy information
on all patients who received IV tPA from 2010-11 at the CSC or CH prior to transfer.
All records were analyzed for the presence of inclusion/exclusion criteria deviations
or tPA errors in prescription, reconstitution, dispensing, or administration, and
for association with outcomes.
Results
We identified 131 AIS cases treated with IV tPA: 51% female; mean age 68; 32% treated
at the CSC, and 68% at CHs (including 26% by telestroke) from 22 CHs. tPA prescription
and administration errors were present in 64% of all patients (41% CSC, 75% CH, P < .001), the most common being incorrect dosage for body weight (19% CSC, 55% CH,
P < .001). Of the 27 overdoses, there were 3 deaths due to systemic hemorrhage or ICH.
Nonetheless, outcomes (parenchymal hematoma, mortality, modified Rankin Scale score)
did not differ between CSC and CH patients nor between those with and without errors.
Conclusion
Despite focus on minimization of tPA administration errors in AIS patients, such errors
were very common in our regional stroke system. Although an association between tPA
errors and stroke outcomes was not demonstrated, quality assurance mechanisms are
still necessary to reduce potentially dangerous, avoidable errors.
Key Words
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Article info
Publication history
Published online: December 11, 2015
Accepted:
November 9,
2015
Received in revised form:
October 26,
2015
Received:
August 14,
2015
Footnotes
Grant support: Dr. Chung received funding from National Institute of Neurological Disorders and Stroke StrokeNet: NIH 1U10NS086606. Dr. Majersik received funding from the National Institutes of Health (significant, >$10k) NIH 1U10NS086606 and minor research funding from Remedy Pharmaceuticals (<$5k).
Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at the University of Utah.
REDCap is a secure, web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry, (2) audit trails for tracking data manipulation and export procedures, (3) automated export procedures for seamless data downloads to common statistical packages, and (4) procedures for importing data from external sources.1Paul A. Harris, Robert Taylor, Robert Thielke, Jonathon Payne, Nathaniel Gonzalez, Jose G. Conde, Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform 2009;42:377-381.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.014
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
