|Acute stroke callout team care is more rapid when an emergency pharmacist ia included: study. |
Researchers from the Pharmacy Department (Faculty of Pharmacy and Pharmaceutical Sciences), the Department of Neuroscience (Central Clinical School) and Department of Epidemiology and Preventive Medicine (School of Public Health and Preventive Medicine) have found that by adding an emergency pharmacist to the acute stroke call-out team provided an improvement in the average time to administer treatment (thrombolysis with alteplase, or recombinant tissue plasminogen activator rtPA) to a patient by 12 minutes.
Most people would be familiar with the F.A.S.T. test recommended by the Stroke Foundation, based on evidence that early intervention can save a person’s life. In the clinical context of management for acute stroke, both the Australian and American Heart / American Stroke Association guidelines recommend providing thrombolysis within 60 minutes of arrival to hospital. Thrombolysis improves functional outcomes for patients so its effective practice is of paramount importance. But in Australia, an audit by the Australian Stroke Foundation in 2019 found that only approximately 30% of patients receive thrombolysis according to the guidelines.
|Timeline of initiatives of acute stroke care in Victoria|
Therefore, what is needed to maximise treatment effectiveness for patients are innovative approaches in acute stroke care procedures.
One such approach was a study published online last month (Roman et al, 2021), which looked at the difference in door-to-needle time (DTNT) between two groups of patients with ischaemic stroke, a retrospective cohort who received thrombolysis as per usual care and compared with a prospective cohort who received the intervention, e.g. addition of an emergency pharmacist after a re-design of the acute stroke response system (in July 2014, see figure).
Professor Geoff Cloud, Head of the Stroke Clinic, Alfred Health and Group leader of the Stroke group, Department of Neuroscience, CCS, commented that although emergency medicine clinical pharmacy is a strongly flourishing area of practice elsewhere, such as North America, emergency pharmacists are not commonly involved in the management of critically unwell patients in Australia. "Their value as medication experts allows clinicians to focus on assessment and diagnosis of stroke and add to the efficiency and accuracy of care provided."
|Ms Cristina Roman|
The collaborative team found that a multi-faceted approach to stroke design, including formal integration of the Emergency Medicine pharmacist into the acute stroke team was associated with improved DTNT for stroke thrombolysis.
As of August 2020 the Emergency Medicine pharmacist has begun to chart all medications required for patients, including intravenous blood pressure medications, thrombolysis and initiation of secondary prevention in line with the Partnered Pharmacist Medication Charting (PPMC) model of care at The Alfred Hospital.
The Alfred Hospital provides emergency and trauma care to approximately 70,000 adult patients a year, being one of the largest hospitals in Australia. Professor Biswadev Mitra, from the Emergency and Trauma Centre, The Alfred Hospital, who led the study said, “We are confident this will also help to reduce delays to care and improve safety.”
The team hopes that further work, including quantifying pharmacist activities in a stroke callout to explore direct impact, external validation and the cost‐effectiveness of 24 hour emergency medicine pharmacist attendance at stroke calls, will provide the necessary evidence to demonstrate the potential value of integrating an emergency medicine pharmacist into acute stroke care.
See more: Roman, C., Cloud, G., Dooley, M. and Mitra, B. (2021), Involvement of emergency medicine pharmacists in stroke thrombolysis: A cohort study. J Clin Pharm Ther. https://doi.org/10.1111/jcpt.13414
- Roman C, Edwards G, Dooley M, Mitra B. Roles of the emergency medicine pharmacist: a systematic review. Am J Health-Syst Pharm.2018;75:796-806.
- Roman CP, Dooley MJ, Mitra B. Emergency Medicine pharmacy practice in Australia: a national survey. J Pharm Pract Res. 2019(49):439-446.
- Department of Health and Human Services, State Government of Victoria: Australia Stroke Care Strategy for Victoria; 2015