Authors (including presenting author) :
Cheng YY(1), Lee MF(1), Ho SH(1), Ng PM(1), Cheung CC(1), Lam LP(1)
Affiliation :
(1)Department of Medicine and Geriatrics, Princess Margaret Hospital
Introduction :
Cluster GMN realized not enough rTPA nurses to run 24/7 service of IV thrombolysis for Hyperacute stroke cases in Yan Chai Hospital (YCH) and Caritas Medical Centre (CMC) of KWC that target starting from 1 July 2019 onwards. Incident of given rTPA after patient received LMWH within 24 hours is another trigger point of prompt alignment of workflow from A&E to ASU in hospitals.
Objectives :
1. To align the practice of rTPA training and line up cluster IV thrombolysis service in KWC. 2. To ensure smooth run of the Cluster call rTPA among KWC neurologist. 3. To enable nurses working in ASU of CMC/PMH/YCH to acquire knowledge and skills in managing hyperacute stroke patients throughout thrombolytic therapy service by 1 July 2019. 4. To improve patient’s outcome after receiving IV rTPA.
Methodology :
Incident of given rTPA after patient receiving LMWH which indicated communication among various parties need enhancement. Development of unified workflow on IV thrombolysis treatment is crucial. Members of KWC Acute Stroke Care Development Coordination Committee (ASCDCC) meet together to align the IV thrombolysis treatment protocol among KWC. The protocol stated the inclusion and exclusion criteria, also indicate direct contact point of Neurologist when potential contraindication encountered. CMC & YCH nurses will have clinical attachment to PMH ASU for IV rTPA training, 2 nurses each from CMC and YCH per batch until 30 Jun 2019. PMH trained rTPA nurses act as mentors in the programme. Participants are assigned as rTPA trainee in each shift and coached by mentors of PMH ASU.Final assessment by Fellow Neurologist when they finished 10 real rTPA call cases. The finalized workflow is adopted after 1 July 2019.CMC, PMH and YCH adopt same IV rTPA training programme and assessment in KWC.
Result & Outcome :
1. Set up agreed unified rTPA call trigger assessment and workflow from A&E to ASU adopt throughout the cluster. 2. By 1 July 2019 at least 50% of nurses in each stroke ward/unit of CMC/PMH/YCH completed the IV thrombolysis training that was adopted by KWC. 3. CMC & YCH nurses have clinical attachment in PMH ASU for IV rTPA training, and complete 10 real cases rTPA call trigger assessment then get pass in the clinical assessment by a Fellow neurologist during the period Dec 2018 – Jul 2019. 4. CMC, PMH and YCH nurses adopted same IV rTPA training programme and have final assessment by KWC Neurologist. 5. Set up a Cluster based training programme in KWC. 6. Improve patient’s outcome after receiving IV rTPA. 1. A unified assessment and workflow from A&E to ASU is agreed and adopted throughout the Cluster. 2. The Door to Needle (DTN) time is maintained (61-90 minutes) which indicated the communication path among Cluster Neurologists and rTPA nurses do not hinder in the process after initiating Cluster call. 3. Patient does not need to transfer from CMC/ YCH to PMH for IV rTPA after 24/7 service since July 2019, which improves the outcome of patients received IV rTPA as reflected by modified Rankin Scale (mRS). The 3-month outcome decreased from 3.29 in Jun to 2.75 in July and further to 1.3 in August 2019. 4. There were total 16 nurses trained to be rTPA nurse in the foresaid period. They successfully passed the assessment by PMH Fellow Neurologist during the period. 5. This aligned training programme will be adopted in hospitals of KWC.
