time goal fibrinolytic checklist

3 min read 01-03-2025

Meta Description: This comprehensive checklist guides healthcare professionals through the crucial steps of administering fibrinolytic therapy within the time goal window, improving patient outcomes in acute ischemic stroke. It covers pre-treatment assessments, medication administration, and post-treatment monitoring, emphasizing efficiency and safety. Learn best practices and reduce delays in this life-saving treatment.

Introduction:

Administering fibrinolytic therapy within the established time window is critical for improving outcomes in patients experiencing acute ischemic stroke. This checklist provides a structured approach to ensure timely and effective treatment, emphasizing both speed and safety. Meeting the time goal for fibrinolytic administration is crucial for minimizing brain damage and maximizing patient recovery.

I. Pre-Treatment Assessment & Preparation: (Target Time: <15 minutes)

A. Immediate Actions:

Confirm Diagnosis: Verify acute ischemic stroke using validated clinical scales (e.g., NIHSS) and neuroimaging (CT scan without contrast).
Assess Eligibility: Confirm patient meets inclusion criteria (e.g., symptom onset <4.5 hours, no contraindications) and exclude exclusion criteria. [Link to NIH Stroke Scale Information]
Establish IV Access: Secure two large-bore IV lines.
Vitals & Labs: Obtain baseline vital signs (including BP, HR, RR, SpO2), blood glucose, and coagulation studies (PT/PTT, INR).

B. Additional Assessments (Concurrent with above):

Neurological Exam: Detailed neurological examination, including NIHSS score. Document findings clearly.
Allergy History: Thoroughly review patient's medication allergies and history.
Medication Reconciliation: Identify all current medications, including anticoagulants and antiplatelet agents.
Consent: Obtain informed consent from the patient or surrogate decision-maker.

II. Fibrinolytic Administration: (Target Time: <1 hour post-decision to treat)

Medication Preparation: Accurately prepare the prescribed dose of tPA (alteplase) according to institutional guidelines. Double-check calculations with a colleague.
Administer tPA: Infuse tPA according to the approved protocol. Begin infusion within 60 minutes of arrival at the facility for stroke treatment, if possible. Carefully monitor for bleeding complications.
Post-Administration Monitoring: Immediately begin monitoring vital signs, including BP, every 15 minutes.

A. Addressing Potential Complications:

Hypotension: Closely monitor blood pressure and manage hypotension according to established protocols. [Link to Hypotension Management Guidelines]
Bleeding: Carefully assess for signs of bleeding (e.g., epistaxis, hematuria, GI bleeding). Have appropriate interventions readily available.

III. Post-Treatment Care & Monitoring:

Neurological Assessments: Repeat neurological examinations (including NIHSS) at regular intervals (e.g., 1 hour, 3 hours, 6 hours, etc.).
Vital Sign Monitoring: Continue vigilant monitoring of vital signs and blood glucose.
Imaging: Consider follow-up neuroimaging (e.g., CT or MRI) to assess treatment response and identify potential complications.
Supportive Care: Provide appropriate supportive care, including hydration, respiratory support, and management of other medical conditions.
Transfer to Specialized Unit: Arrange for transfer to a stroke unit or appropriate inpatient setting for ongoing care.

IV. Documentation:

Time-Sensitive Documentation: Meticulously document all times related to symptom onset, arrival at the facility, completion of assessments, medication administration, and post-treatment monitoring.
Complete Charting: Thorough documentation of all assessments, interventions, and patient responses is essential for both legal and clinical purposes.

V. Addressing Common Delays:

Rapid Triage: Implement rapid triage protocols to expedite patient evaluation and treatment.
Teamwork & Communication: Foster strong communication and collaboration among the healthcare team to optimize efficiency.
Dedicated Stroke Team: Consider establishing a dedicated stroke team to manage these cases effectively.
Pre-Hospital Notification: Utilize pre-hospital notification systems to prepare the hospital for the patient's arrival and expedite treatment.

Conclusion:

Adhering to this time goal fibrinolytic checklist will help ensure the safe and effective administration of fibrinolytic therapy to patients with acute ischemic stroke. Improving speed and efficiency in treatment directly impacts patient outcomes and reduces long-term disability. Remember, teamwork, clear communication, and diligent adherence to protocols are crucial components of successful stroke care. By using this checklist as a guide, healthcare professionals can significantly contribute to improving patient care and ultimately saving lives.