Improving Nursing Skills In Acute Stroke Patients Can Reduce The Time-to-treatment

INTRODUCTION: Intravenous tPa treatment is time dependent. The management of Hypertension (HTN) and Hyperglycemia (HGL), along with blood sample collection in the emergency room (ER) may cause delays in tPa treatment, if not performed at the same time that the neurologist is examining the patient. Our aim was to determine whether the emergency nursing professional skills can reduce the delay on tPa administration during the emergency room stay. Methodology: This is a prospective study of acute stroke patients evaluated in the ER. Time from presentation to the ER to treatment was evaluated (time to treatment decision). This time was considered delayed if it was more than 40 minutes. Exact times of nursing activities were recorded as well as the causes that can impact delay and can be solved by nursing professionals (baseline hypertension, hyperglycemia and time to blood sample collection). Results: From January to July 2012, 222 patients were evaluated. 50% were men, mean age of 71,1 ,and mean time spent in the ER was 18±9 minutes. 35 patients where hypertensive on admission(15,8%), 59 had hyperglycemia(26,6%) and 11 had both(5%). Mean time to obtain blood sample was 5±3 minutes. Seventy-three patients(32,8%) were treated with intravenous tpa. Door-to-needle time was 39±19 minutes and CT-to-bolus time 11±4 minutes. In up to 29 times, a cause of delay in tPa initiation >40minutes was identified. Of those, 11 were related to nursing actions: 4(14,8%) blood sample delays and 7(25,9%) delays in treatment of HBP or HGL. Conclusions: Emergency nursing professionals have a very important role in acute stroke and developing skills and training may reduce time-to-treatment. A specialized stroke code nurse would probably improve stroke management in emergency room.