Marrinan Elizabeth, Chen Lucia, Werring David, Turner David
Hyper-acute Stroke Unit, University College London Hospital, London, UK.
Acute Stroke and Brain Injury Unit, National Hospital for Neurology and Neurosurgery, London, UK.
Br J Hosp Med (Lond). 2020 Feb 2;81(2):1-6. doi: 10.12968/hmed.2020.0007. Epub 2020 Feb 13.
BACKGROUND/AIMS: Four-factor prothrombin complex concentrate is the first-line treatment in vitamin K antagonist-related intracerebral haemorrhage. Early administration is associated with improved patient outcomes. A quality improvement project investigated delays in prothrombin complex concentrate administration in vitamin K antagonist-related intracerebral haemorrhage in order to reduce the time from computed tomography scan confirming intracerebral haemorrhage to prothrombin complex concentrate administration (scan-to-needle time).
Twenty patients were identified by retrospective audit over a 3-year period. The median scan-to-needle time for prothrombin complex concentrate was 156 minutes. Several points of delay were identified, including contacting both haematology and transfusion departments for prothrombin complex concentrate dosing and dispensing. Following this audit, interventions were brought in which included the introduction of a protocol with a prothrombin complex concentrate dosing algorithm, negating the need to contact haematology before administration. A dedicated supply of prothrombin complex concentrate was given to the stroke unit avoiding the need to contact the transfusion service.
A re-audit showed a 68% reduction in median scan-to-needle time from 156 minutes to 49 minutes. Prospective data collection is ongoing.
背景/目的：四因子凝血酶原复合物浓缩剂是维生素K拮抗剂相关脑出血的一线治疗药物。早期给药与改善患者预后相关。一项质量改进项目调查了维生素K拮抗剂相关脑出血患者凝血酶原复合物浓缩剂给药的延迟情况，以缩短从计算机断层扫描确认脑出血到给予凝血酶原复合物浓缩剂的时间（扫描到用药时间）。
通过回顾性审核在3年期间确定了20例患者。凝血酶原复合物浓缩剂的中位扫描到用药时间为156分钟。确定了几个延迟点，包括联系血液科和输血科进行凝血酶原复合物浓缩剂的给药和配药。此次审核后，采取了一些干预措施，包括引入带有凝血酶原复合物浓缩剂给药算法的方案，无需在给药前联系血液科。为卒中单元专门提供凝血酶原复合物浓缩剂，无需联系输血科。
重新审核显示，中位扫描到用药时间从156分钟减少了68%，降至49分钟。前瞻性数据收集正在进行中。
