Abstract W P350: A Quality Enhancement Project to Capture Actual Weights Prior to Initiation of IV t-PA

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oregon; portland; PPMC


Background/Issues: The AHA/ASA commends the formation of multidisciplinary quality improvement teams in order to achieve high level organization and efficiency in the treatment of acute stroke. Emanuel Medical Center’s process in obtaining weight information was determined by two provider estimations. Historical review of charts revealed over and under dosing of IV tPA. This quality enhancement project was designed to develop a process to capture actual weights prior to the initiation of IV tPA.

Purpose: Have 100% acute ischemic stroke patients weighed prior to tPA administration.

Method: Utilizing Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team consisting of Neurologist, Stroke Coordinator RN, ED Supervisor, and Stroke NP was created to establish a standard method in obtaining weights in the ED. The team identified a shortage of scales, lack of designated location, and absence of weighing patients in the ED workflow as main barriers. Review of current literature and institutional policies led to a proposal for new scales, designated location, development of standardized process for timing of weighing patients, and entering information in chart. Additional interventions involved extensive education of staff through active and passive learning methods with development of an educational module for ED staff. One month post implementation and cycle analysis of PDSA, ED supervisor discovered new stretcher scales required being plugged in for operation. The new clinical practice algorithm includes the following steps: arrival by EMS and taking patient directly to CT; placement on CT table; patient transfer onto stretcher scale post scan; plugging-in scale; obtaining weight; and entering into chart.

Results: Compliance was 0% (0/3) in the first month of implementation and 100% in the two consecutive months (6/6), and (1/1). All cases reviewed by the Stroke Coordinator and ED supervisor (inter-rater reliability of Cohen’s kappa 0.71). Feedback is given on all cases within 48 hours to the stroke leadership team. ED supervisor provides staff feed-back and analyzes outliers.

Conclusion: Developing a standard process for capturing actual weights in the ED prior to initiating tPA is feasible utilizing PDSA methodology

Clinical Institute

Neurosciences (Brain & Spine)