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Tissue Plasminogen Activator Prescription and Administration Errors within a Regional Stroke System.
Chung, Lee S; Tkach, Aleksander; Lingenfelter, Erin M; Dehoney, Sarah B; Rollo, Jeannie; de Havenon, Adam; DeWitt, L Dana; Grantz, Matthew R; Wang, Haimei; Wold, Jana J; Hannon, Peter M; Weathered, Natalie R; Majersik, Jennifer J.
Affiliation
  • Chung LS; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • Tkach A; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • Lingenfelter EM; Inpatient Pharmacy Services, University of Utah, Salt Lake City, Utah.
  • Dehoney SB; Inpatient Pharmacy Services, University of Utah, Salt Lake City, Utah.
  • Rollo J; Inpatient Pharmacy Services, University of Utah, Salt Lake City, Utah.
  • de Havenon A; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • DeWitt LD; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • Grantz MR; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • Wang H; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • Wold JJ; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • Hannon PM; Department of Neurology, University of Utah, Salt Lake City, Utah.
  • Weathered NR; Department of Neurology, Weill Cornell Medical College, New York, New York.
  • Majersik JJ; Department of Neurology, University of Utah, Salt Lake City, Utah. Electronic address: Jennifer.majersik@hsc.utah.edu.
J Stroke Cerebrovasc Dis ; 25(3): 565-71, 2016 Mar.
Article in En | MEDLINE | ID: mdl-26698642
BACKGROUND: Intravenous (IV) tissue plasminogen activator (tPA) utilization in acute ischemic stroke (AIS) requires weight-based dosing and a standardized infusion rate. In our regional network, we have tried to minimize tPA dosing errors. We describe the frequency and types of tPA administration errors made in our comprehensive stroke center (CSC) and at community hospitals (CHs) prior to transfer. METHODS: Using our stroke quality database, we extracted clinical and pharmacy information on all patients who received IV tPA from 2010-11 at the CSC or CH prior to transfer. All records were analyzed for the presence of inclusion/exclusion criteria deviations or tPA errors in prescription, reconstitution, dispensing, or administration, and for association with outcomes. RESULTS: We identified 131 AIS cases treated with IV tPA: 51% female; mean age 68; 32% treated at the CSC, and 68% at CHs (including 26% by telestroke) from 22 CHs. tPA prescription and administration errors were present in 64% of all patients (41% CSC, 75% CH, P < .001), the most common being incorrect dosage for body weight (19% CSC, 55% CH, P < .001). Of the 27 overdoses, there were 3 deaths due to systemic hemorrhage or ICH. Nonetheless, outcomes (parenchymal hematoma, mortality, modified Rankin Scale score) did not differ between CSC and CH patients nor between those with and without errors. CONCLUSION: Despite focus on minimization of tPA administration errors in AIS patients, such errors were very common in our regional stroke system. Although an association between tPA errors and stroke outcomes was not demonstrated, quality assurance mechanisms are still necessary to reduce potentially dangerous, avoidable errors.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Drug Prescriptions / Tissue Plasminogen Activator / Stroke / Fibrinolytic Agents / Hospitals, Community Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: J Stroke Cerebrovasc Dis Journal subject: ANGIOLOGIA / CEREBRO Year: 2016 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Drug Prescriptions / Tissue Plasminogen Activator / Stroke / Fibrinolytic Agents / Hospitals, Community Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: J Stroke Cerebrovasc Dis Journal subject: ANGIOLOGIA / CEREBRO Year: 2016 Document type: Article Country of publication: United States