Pharmacist Impact on Ischemic Stroke Care in the Emergency Department.

ABSTRACT

BACKGROUND: The Froedtert Acute Stroke Team (FAST) is composed of various health professionals who respond to stroke calls, but it does not formally include a pharmacist at this time. However, emergency department (ED) pharmacists have been actively involved in patient evaluation and facilitation of i.v. recombinant tissue plasminogen activator (rtPA) preparation and administration in the ED. ED pharmacists are qualified to dose and prepare rtPA, as well as screen for contraindications to therapy. OBJECTIVE: The primary objective was to compare the accuracy of rtPA dosing, mean door-to-rtPA time, and identification of contraindications to rtPA therapy when a pharmacist was present vs. absent in the ED. METHODS: This is a retrospective study of 105 patients who received rtPA for acute ischemic stroke in the ED at a comprehensive stroke center from January 1, 2008 to October 1, 2012. RESULTS: A total of 105 patients were included in this study. Dosing accuracy was similar when a pharmacist was present vs. absent (96.6% vs. 95.6%; p = 0.8953). The median door-to-rtPA time when a pharmacist was present was statistically significantly shorter than when a pharmacist was absent (69.5 vs. 89.5 min; p = 0.0027). When a pharmacist was present, a door-to-rtPA time of < 60 min was achieved 29.9% of the time, as compared with 15.8% in the pharmacist-absent group (p = 0.1087). CONCLUSIONS: Pharmacist involvement on stroke teams may have a beneficial effect on door-to-rtPA time and patient care in the ED.