This is the PICOT for my project: In adult stroke patients arriving at the emergency
department, does the administration of thrombolytic therapy within 30
minutes of arrival compared to standard care, lead to improved clinical
outcomes such as reduced disability and mortality rates within the acute
phase of stroke management?
Using the information already compiled in previous assignments, create a proposal of at least 8 pages (not including the Title page and Reference page) which includes:
- A Title Page including a title for your project
- A Literature Review supporting the need for the project
- At least 5 or more peer reviewed articles supporting the proposal
- Objectives and strategies for achievement of the Capstone project
- Background for the proposal including supportive resources indicated throughout the course e.g. budgeting, outcomes, evaluations.
- Formatting using APA style.
- APA 7th edition format of the American Psychological Association (APA) is the official style used by Nightingale College. This style and format used to cite sources can be referenced from http://www.apastyle.org
Write the paper using APA style and upload to this drop box by the due date. Please review the rubric used to give feedback for more information.
I’ve included my literary review for reference….
This was my Literary review:
Literature
Review
While
everyone’s life is different, the story of people who have had a stroke is a
powerful example of resilience, adaptation, and how hard it is to get better.
Patients who are 18 years or older, have experienced an ischemic stroke and are
admitted to the hospital will receive thrombolytic therapy treatment within 30
minutes of arrival time. The standard of care at the current time is a window
of 3-4 hours from onset of symptoms. The outcome of this project is to have the
patient achieve an increased likelihood of independence in ADLs at time of
discharge. The purpose of this paper is to educate the population on stroke
symptoms and acting F.A.S.T in order to get expedited treatment to minimize any
deficits the stroke may have caused.
Methods
of Searching
A literature review was conducted using both electronic
and manual resources from the internet using Google search engine and also a
manual search using policies and procedures from Sutter Health. I used websites
such as NIH, AHA and ASA. The manual search was done at Sutter Health with
reading through policies and procedures related to the protocol and how these
duties are carried out. I reviewed the policies specific to the emergency
department. The policies I researched at Sutter Health outline the times
related to door to treatment of thrombolytics for ischemic strokes.
Project
Proposal Topic
The proposed
project is to optimize the door-to-thrombolytic treatment time for patients
presenting with acute ischemic stroke. Time is of the essence in stroke
management, and evidence suggests that early administration of thrombolytic
therapy significantly improves outcomes. Therefore, this project seeks to
implement streamlined protocols and workflow strategies aimed at reducing the
time from a patient’s arrival at the hospital door to the treatment with
thrombolytic therapies. By managing the innerworkings and collaboration,
technology integration, and staff education initiatives, we aim to achieve a
significant reduction in door-to-treatment times, ultimately improving patient
outcomes and minimizing disability. Through meticulous monitoring and evaluation
of process metrics and patient outcomes, this project will contribute to the
ongoing optimization of stroke care delivery, ensuring that patients receive
timely and effective treatment to maximize their chances of recovery.
Review
of the LiteratureBottom of Form
Guidelines for the early management of patients
with acute ischemic stroke play a crucial role in optimizing patient care and outcomes.
These guidelines, informed by extensive research and expert unity, provide
evidence-based recommendations for healthcare professionals involved in the
acute management of stroke patients. They encompass a comprehensive approach,
addressing important aspects such as rapid assessment, diagnostic evaluation,
initiation of thrombolytic therapy when appropriate, and the implementation of
supportive measures to mitigate secondary complications. By adhering to these
guidelines, healthcare teams can ensure timely and standardized care delivery,
thereby minimizing treatment delays, reducing the extent of neurological
damage, and enhancing the potential recovery for stroke patients. These
guidelines serve as a base for quality improvement initiatives, promoting
continuous advancements in stroke care practices and maintaining a culture of
excellence in stroke management across healthcare settings.
In July 2019, the AHA released an article
detailing the case of a 35-year-old woman who was discovered paralyzed in a
store bathroom. She had experienced migraine-like headaches for the previous
three weeks and got medical attention at an external hospital, where she
underwent evaluation, including a non-contrast CT scan of the head and a lumbar
puncture, both showing normal results. During a shopping trip which marked her
first outing following clearance from the emergency room, she suddenly
experienced a sensation of feeling “weird” and excused herself to the
restroom, where her mother found her several minutes later with left-sided
paralysis and confusion. Paramedics were called, and they suspected the woman
was suffering from a stroke. Countless similar stories underscore the
importance of stroke guidelines, which have since been established and widely
adopted worldwide. Recognizing the symptoms of a stroke: Face
drooping, Arm weakness, Slurred speech, Time can save a
life and be the difference between permanent or temporary paralysis/deficits. (AHAJournals,
2019)
The
National Library of Medicine has conducted research on emergency department
arrival to needle time called “door-to-needle” time in patients with acute
stroke. (NCBI, NLM, 2023) The data was extracted and analyzed from the Get With
The Guidelines Stroke Registry. This stroke registry not only looks at what
time the patient was brought to the hospital (day and night), the arrival to
medication time, time to CT and time to lab, but also whether there was a
dedicated “stroke team” to take care of the patient. What they found was very
interesting. The median DTN (door to needle) time for the day shift was 37
minutes and the DTN for the night shift was 59 minutes. The DTN time was 36
minutes when the stroke team was present compared to 51 minutes when there was
no designated stroke team. (NCBI, 2023)
The Heart.org provides comprehensive coverage
on all aspects related to strokes. Within its resources, you’ll find the
“Get With The Guidelines” registry, which offers a wealth of
quantitative data collected from the onset of stroke symptoms to the patient’s
discharge and return home. Additionally, the website offers guidance on
obtaining stroke certifications for hospitals, detailing the various
certification levels based on available resources. It also offers valuable
information on stroke types, recognizing stroke symptoms, and emphasizes the
importance of having a well-educated hospital staff equipped with resources for
optimal patient outcomes. Additionally, there’s a dedicated section on stroke
survivors, highlighting how sharing their experiences aids in emotional,
mental, and physical recovery. (Stroke.org, 2021)
Findings
Research indicates that individuals who
promptly seek medical attention upon experiencing stroke-like symptoms tend to
achieve better outcomes and exhibit fewer deficits. Delaying hospital arrival
significantly affects the brain’s condition, potentially leading to permanent
deficits. Therefore, calling 9-1-1 and receiving prehospital care are crucial
steps in ensuring a positive outcome for stroke patients. Literature also
suggests that early administration of thrombolytic medication, aimed at
dissolving clots in ischemic strokes, has a direct correlation with improved
outcomes and reduced deficits. Therefore, swift access to thrombolytic
treatment is paramount in mitigating the impact of ischemic strokes.
Apart from the timely access to medical care,
hospitals certified as stroke centers and equipped with specialized teams, like
stroke teams, have demonstrated a remarkable ability to shorten the
door-to-needle time by 15 minutes for patients experiencing ischemic stroke.
Ensuring that staff members are well-trained and competent is equally important
in optimizing stroke care. Regular trainings are required to ensure that
healthcare professionals remain up to date with the latest research findings
and advancements in stroke management. This commitment to ongoing education and
skill refinement is essential for delivering the highest quality of care and
improving patient outcomes.
Conclusion
In conclusion, the management of acute ischemic
stroke demands a multifaceted approach that encompasses timely intervention,
specialized care, and continuous staff education. The literature outlines the
critical importance of seeking immediate medical attention upon experiencing
stroke-like symptoms, as prompt treatment significantly improves outcomes and
reduces long-term deficits. The establishment of stroke centers staffed with
specialized teams has proven crucial in expediting treatment delivery and optimizing
patient care. Additionally, the ongoing training and education of healthcare
professionals are paramount in ensuring that stroke management practices remain
aligned with the latest research findings and best practices, ultimately
contributing to enhanced patient outcomes and quality of life. By adhering to
these principles and continuously striving for excellence, healthcare systems
can further advance stroke care and support the journey towards improved
patient recovery and well-being.
References
U.S. National Library of
Medicine. (2023, March 30). Home – PMC – NCBI. National Center for
Biotechnology Information.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10098073/
Thrombolytic therapy for
acute ischemic stroke | stroke. (2019, July 22). https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.025699
Guidelines for the early
management of patients with acute ischemic … (2020). https://www.ahajournals.org/doi/10.1161/STR.0000000000000211
The Joint Commission
Standards Interpretation Group. (2021, October 26). Patient management tool-
get with the guidelines (GWTG) compared to Joint Commission: Advanced DSC –
Acute Stroke Ready Hospital: Performance Measurement DSPM. The Joint
Commission.
https://www.jointcommission.org/standards/standard-faqs/advanced-dsc—acute-stroke-ready-hospital/performance-measurement-dspm/000001607/
Warning signs. The Stroke Foundation. (2021, April 21).