Abstract WP468: Nurse Role Expedites Triage during Stroke Alert to Improve IV Alteplase Door to Needle Times

Background: Comprehensive Stroke Center strives to meet IV Alteplase Door to Needle Times (DTNt) of less than (<) 45 minutes. In addition, a new electronic medical record (EMR) was expected to slow the stroke alert (SA) process. An action plan focusing on the Registered Nurse (RN) role to expedite triage and impact response times to improve DTNt was implemented while transitioning to a new EMR. Purpose: Improve DTNt through focused education on the RN role to expedite triage and impact response times in the Emergency Department (ED) while transitioning to a new EMR. Methods: RNs participated in classroom education regarding required SA time goals to include time last known well, NIHSS, door to CT, door to lab, door to physician, and door to needle. An audit tool was created to include these categories to document times during the SA process. A focus was placed on the role of the RN to expedite triage in order to meet door to needle time goals. After classroom education RNs completed the audit tool on each SA for a 6 month period that also included transition to the new EMR (phase 1). To evaluate impact of the new EMR on the SA process and continued compliance following education, DTNt were evaluated for an additional 6 month period (phase 2). Results: Prior to RN education, creation of the audit tool and new EMR implementation, the DTNt were 31% (4/13) < 45 minutes and 54% (7/13) < 60 minutes. During phase 1 there was a slight decline in DTNt < 45 minutes to 20% (3/15), with an increase in DTNt < 60 minutes to 73% (11/15). Phase 2 showed continued improvement with an increase in DTNt < 45 minutes to 67% (6/9) and DTNt < 60 minutes to 89% (8/9). Conclusions: RNs play a pivotal role in the hyper acute phase of stroke care. Classroom education focusing on the RN role to expedite triage and the utilization of an audit tool focusing on required SA time goals impacted response in the ED and improved DTNt during transition to a new EMR. Completion of the audit tool assisted the RN to meet door to needle goals during the learning phase of a new EMR and continued to improve performance after the change.