提升急性缺血性腦中風病人施打rt-PA＜60分鐘比例

Increasing Administration Ratio of Recombinant Tissue-type Plasminogen Activator within 60 Minutes of Diagnosis of Acute Ischemic Stroke

林霏儀(Fei-Yi Lin) ； 黃繼瑩(Chi-Ying Huang) ； 鄭榮娟(Jung-Chuan Cheng) ； 黃麗華(Li-Hua Huang)

《新臺北護理期刊》 17卷2期 (2015/09) Pp. 47-56

https://doi.org/10.6540/NTJN.2015.2.005

摘要

急性缺血性腦中風病人發病黃金搶救三小時內，靜脈施打血栓溶解劑（rt-PA）能提升神經功能恢復。本院急診2012/1/1-12/31急性缺血性腦中風病人符合施打者共16人，小於60分鐘內施打者僅達25%，主要原因：檢傷判斷錯誤導致遺漏、延遲啟動照會、不清楚為緊急照會、放射科未優先排檢、檢驗科回報血液檢查報告時間長、缺乏完整評估說明單、醫護人員對rt-PA使用不熟悉。專案目的為提升靜脈施打rt-PA＜60分鐘比例至50%。經制定照護標準、制定緊急照會機制、制定檢查及檢體快速執行流程、建置會診及檢查警示系統、制定rt-PA治療流程單與專用醫囑單、舉辦在職教育。施打rt-PA＜60分鐘比例由25%提升至55.6%。期望藉此專案分享跨團隊合作讓病人得以盡早獲得妥善治療，進而提升照護品質。

關鍵字

缺血性腦中風 ； 血栓溶解劑 ； 施打rt-PA＜60分鐘

並列摘要

Intravenously administered thrombolytic recombinant tissue-type Plasminogen Activator (rt-PA) agent, when given within the first 3 hours of stroke onset, is the most effective treatment for the recovery of neurological functions in acute ischemic stroke (AIS) patients. However, in the emergency department of the hospital in this study, from January 1, 2012 to December31, 2012, 16 patients met the requirements for rt-PA administration, but only 25% received rt-PA within 60 minutes of admission. The reasons for this low rt-PA administration rate are (1) misdiagnosis by the triage, (2) delayed consultation, (3) consulting physicians not aware of emergent consultation, (4) patients not prioritized for evaluation by the Radiology Department, (5) delayed laboratory results, (6) the lack of a complete assessment form, and (7) medical staff not familiar with the use of rt-PA. The purpose of this project is to increase the rate of rt-PA (door-to-needle time less than 60 minutes) administration to 50 %. We propose the following solutions: (1) establish a standard of care; (2) establish an emergency consultation procedure; (3) establish an accelerated evaluation process; (4) establish consultation and evaluation alert systems; (5) establish rt-PA treatment procedure and specialized care instruction forms; and (6) arrange staff education seminars. The rt-PA (DTN of less than 60 minutes) administration rate increased from 25.0 % to 55.6 %. This project was able to provide timely treatment and improved quality care for AIS patients through the efforts and cooperation of different medical care teams.

並列關鍵字

Acute ischemic stroke ； Recombinant tissue-type plasminogen activator (rt-PA) ； Rt-PA administration in less than 60 minutes of door-to-needle time

參考文獻

Jeffrey, L. S., Gregg, C. F., Eric, E. S., Mathew, J. R., Maria, V. G., Wenqin, P.,…Lee, H. S. (2013). Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke. JAMA, 309(23), 2480-2488. doi: 10.1001/jama.2013.6959

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