Having a pharmacist at stroke patient's bedside speeds administration of critical drug

The faster rtPA is given, the better the outcome. Now a Loyola Medicine study has found that having a pharmacist at the patient's bedside can reduce the time it takes to administer rtPA by a median of 23.5 minutes.

The study by pharmacists Megan A. Rech, PharmD, Stephanie Bennett, PharmD, and Elisabeth Donahey, PharmD, is published in the journal Annals of Pharmacotherapy.

Each year, about 800,000 people in the United States have a stroke -- about one person every 40 seconds. Stroke is the fifth leading cause of death in the United States.

Most strokes are ischemic, meaning they are caused by blood clots that block blood flow to areas of the brain. Every minute a stroke goes untreated, about 1.9 million brain cells die.

If given quickly enough, recombinant tissue plasminogen activator (rtPA) can in some cases dissolve the clot, restore blood flow and minimize damage. The drug is given intravenously. The American Heart Association/American Stroke Association guidelines for ischemic stroke recommend giving eligible patients rtPA within 60 minutes of hospital arrival (known as door-to-needle time).

But rtPA is not indicated for all stroke patients. For example, if a patient's stroke is due to a brain bleed, administering blood thinning rtPA could make the bleed worse.

Pharmacists can help evaluate rtPA contraindications, elicit and review medical histories and medication lists, manage blood pressure, calculate the rtPA dose, reconstitute and administer rtPA with the bedside nurse, counsel patients and/or family members on the risks and benefits of the drug and monitor the patient after rtPA administration.

The Loyola researchers retrospectively studied 125 ischemic stroke patients who received rtPA. Forty-five patients had a pharmacist present and 80 patients did not. When a pharmacist was present, there was a 49 percent increase in the percentage of patients who received rtPA within the recommended 60 minutes or less.

The study is the largest to date to explore the impact of having a pharmacist at the bedside. It included patients who were admitted to the emergency department and patients who suffered strokes while in the hospital. The study also adjusted for confounding factors such as whether a patient was treated during the day or at night or during the week or on the weekend.

The study, researchers concluded, "supports utilization of pharmacists as members of the stroke response team to optimize door-to-needle goal attainment in acute ischemic stroke."