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
Department of Neurology, University of Utah, Salt Lake City, Utah.
Inpatient Pharmacy Services, University of Utah, Salt Lake City, Utah.
J Stroke Cerebrovasc Dis. 2016 Mar;25(3):565-71. doi: 10.1016/j.jstrokecerebrovasdis.2015.11.014. Epub 2015 Dec 11.
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.
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.
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.
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.
急性缺血性卒中（AIS）患者静脉注射组织型纤溶酶原激活剂（tPA）需要根据体重给药并采用标准化输注速率。在我们的区域网络中，我们一直致力于尽量减少tPA给药错误。我们描述了在我们的综合卒中中心（CSC）和社区医院（CHs）转运前tPA给药错误的频率和类型。
利用我们的卒中质量数据库，我们提取了2010年至2011年在CSC或CH转运前接受静脉tPA治疗的所有患者的临床和药学信息。分析所有记录中是否存在纳入/排除标准偏差或tPA在处方、复溶、配药或给药方面的错误，并分析其与结局的相关性。
我们确定了131例接受静脉tPA治疗的AIS病例：女性占51%；平均年龄68岁；32%在CSC接受治疗，68%在CHs接受治疗（包括22家CHs中26%通过远程卒中治疗）。64%的患者存在tPA处方和给药错误（CSC为41%，CH为75%，P < 0.001），最常见的是体重剂量错误（CSC为19%，CH为55%，P < 0.001）。在27例用药过量病例中，有3例因全身性出血或颅内出血死亡。尽管如此，CSC和CH患者之间以及有错误和无错误患者之间的结局（脑实质血肿、死亡率、改良Rankin量表评分）并无差异。
尽管致力于尽量减少AIS患者的tPA给药错误，但此类错误在我们的区域卒中系统中非常常见。虽然未证明tPA错误与卒中结局之间存在关联，但仍需要质量保证机制来减少潜在的危险且可避免的错误。
