Enhancing blood pressure management protocol implementation in patients with acute intracerebral haemorrhage through a nursing-led approach: A retrospective cohort study.

AIM: To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients. DESIGN: Retrospective cohort study of prospectively collected data over 6 years. METHODS: Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan. We differentiated six periods: P1, stroke nurse at computed tomography suite (baseline period); P2, antihypertensive titration by stroke nurse; P3, retraining by neurologists; P4, integration of a stroke advanced practice nurse; P5, after COVID-19 impact; and P6, retraining by stroke advanced practice nurse. Outcomes included first-hour target achievement (primary outcome), tomography-to-treatment and treatment-to-target times, first-hour maximum dose of antihypertensive treatment and 6-h and 24-h systolic blood pressure variability. RESULTS: Compared to P1, antihypertensive titration by stroke nurses (P2) reduced treatment-to-target time and increased the rate of first-hour target achievement, retraining of stroke nurses by neurologists (P3) maintained a higher rate of first-hour target achievement and the integration of a stroke advanced practice nurse (P4) reduced both 6-h and 24-h systolic blood pressure variability. However, 6-h systolic blood pressure variability increased from P4 to P5 following the impact of the COVID-19 pandemic. Finally, compared to P1, retraining of stroke nurses by stroke advanced practice nurse (P6) reduced tomography-to-treatment time and increased the first-hour maximum dose of antihypertensive treatment. CONCLUSION: Changes in nursing care and continuous education can significantly enhance the time metrics and blood pressure outcomes in acute intracerebral haemorrhage patients. REPORTING METHOD: STROBE guidelines. PATIENT AND PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Implementación de un protocolo de transferencia directa y movilización del equipo de ictus para reducir los tiempos de reperfusión / Implementation of a protocol for direct stroke patient transfer and mobilization of a stroke team to reduce times to reperfusion

Objetivos. El tiempo es un factor clave en el tratamiento y pronóstico del ictus. Nuestro centro ha implementado un protocolo de Actuación Rápida Puerta Aguja (ARPA) para optimizar los tiempos de reperfusión. Este protocolo intrahospitalario consiste en tratar a los pacientes derivados por código ictus (CI) directamente en el escáner o en la sala de angiografía movilizando al equipo de ictus. Los objetivos son evaluar el impacto del protocolo ARPA en los tiempos de reperfusión, y valorar la viabilidad y seguridad de incorporar un enfermero de la unidad de ictus (UI) al equipo de ictus para la asistencia a pacientes CI, así como la satisfacción de los profesionales. Método. Estudio descriptivo de pacientes atendidos en el circuito CI entre marzo 2015 y marzo 2018. Se compararon con el periodo previo entre febrero 2014 y febrero 2015. Resultados. Se atendieron 903 pacientes con el protocolo ARPA y recibieron tratamiento de reperfusión 502 pacientes (55,6%). La mediana de tiempo puerta-aguja para fibrinolisis fue de 24 (18-33) minutos y puerta-punción para trombectomía 39 (20-75) minutos, ambos inferiores (p < 0,001) al periodo anterior, que tuvo unos tiempos de 43 (31-66) y 93 (60-150) minutos, respectivamente. El enfermero atendió los CI durante 25 (20-32) minutos, y no se encontraron problemas graves de seguridad o viabilidad. Veinte profesionales (95%) refirieron que el protocolo ARPA aumentaba su carga de trabajo pero consideraron que se debía seguir aplicando. Conclusiones. El tratamiento de pacientes CI directamente en el escáner o en la sala de angiografía incorporando un enfermero de la UI reduce, de forma segura, los tiempos de reperfusión

Background and objectives. The timing of treatment is a key prognostic factor in stroke. Our hospital implemented a rapid-action time-to-intervention protocol to optimize reperfusion times. The protocol consisted of direct transfer of stroke-code patients to the scanner or angiosuite and mobilization of the stroke team. Our aim was to assess the impact of the protocol on times to reperfusion. We also sought to evaluate the feasibility and safety of including a stroke-team nurse and assess staff satisfaction with the protocol. Methods. Descriptive study of patients attended by the hospital stroke team between March 2015 and March 2018. Outcomes were compared to those for the previous period (February 2014 to February 2015). Results. Nine hundred three patients were attended under the rapid-action protocol; 502 of them (55.6%) underwent reperfusion. The median (interquartile range) door-to-needle or groin access times were 24 (18-33) minutes for fibrinolysis and 39 (20-75) minutes for thrombectomy. Both times were significantly shorter than in the earlier period (43 [31-66] and 93 [60-150] minutes, respectively; P<.001). Median duration of nurse attendance was 25 (20-32) minutes during the implementation period, and no problems of feasibility or safety appeared during nurse attendance. Twenty staff members (95%) reported that the rapid-action protocol increased their workload but they felt it warranted continued application. Conclusion. Direct transfer of stroke patients for scanning or to the angiography suite, with nurse attendance, safely reduced reperfusion times

Implementation of a protocol for direct stroke patient transfer and mobilization of a stroke team to reduce times to reperfusion. / Implementación de un protocolo de transferencia directa y movilización del equipo de ictus para reducir los tiempos de reperfusión.

OBJECTIVES: The timing of treatment is a key prognostic factor in stroke. Our hospital implemented a rapid-action time-to-intervention protocol to optimize reperfusion times. The protocol consisted of direct transfer of stroke-code patients to the scanner or angiosuite and mobilization of the stroke team. Our aim was to assess the impact of the protocol on times to reperfusion. We also sought to evaluate the feasibility and safety of including a stroke-team nurse and assess staff satisfaction with the protocol. MATERIAL AND METHODS: Descriptive study of patients attended by the hospital stroke team between March 2015 and March 2018. Outcomes were compared to those for the previous period (February 2014 to February 2015). RESULTS: Nine hundred three patients were attended under the rapid-action protocol; 502 of them (55.6%) underwent reperfusion. The median (interquartile range) door-to-needle or groin access times were 24 (18-33) minutes for fibrinolysis and 39 (20-75) minutes for thrombectomy. Both times were significantly shorter than in the earlier period (43 [31-66] and 93 [60-150] minutes, respectively; P<.001). Median duration of nurse attendance was 25 (20-32) minutes during the implementation period, and no problems of feasibility or safety appeared during nurse attendance. Twenty staff members (95%) reported that the rapid-action protocol increased their workload but they felt it warranted continued application. CONCLUSION: Direct transfer of stroke patients for scanning or to the angiography suite, with nurse attendance, safely reduced reperfusion times.

OBJETIVO: El tiempo es un factor clave en el tratamiento y pronóstico del ictus. Nuestro centro ha implementado un protocolo de Actuación Rápida Puerta Aguja (ARPA) para optimizar los tiempos de reperfusión. Este protocolo intrahospitalario consiste en tratar a los pacientes derivados por código ictus (CI) directamente en el escáner o en la sala de angiografía movilizando al equipo de ictus. Los objetivos son evaluar el impacto del protocolo ARPA en los tiempos de reperfusión, y valorar la viabilidad y seguridad de incorporar un enfermero de la unidad de ictus (UI) al equipo de ictus para la asistencia a pacientes CI, así como la satisfacción de los profesionales. METODO: Estudio descriptivo de pacientes atendidos en el circuito CI entre marzo 2015 y marzo 2018. Se compararon con el periodo previo entre febrero 2014 y febrero 2015. RESULTADOS: Se atendieron 903 pacientes con el protocolo ARPA y recibieron tratamiento de reperfusión 502 pacientes (55,6%). La mediana de tiempo puerta-aguja para fibrinolisis fue de 24 (18-33) minutos y puerta-punción para trombectomía 39 (20-75) minutos, ambos inferiores (p < 0,001) al periodo anterior, que tuvo unos tiempos de 43 (31-66) y 93 (60-150) minutos, respectivamente. El enfermero atendió los CI durante 25 (20-32) minutos, y no se encontraron problemas graves de seguridad o viabilidad. Veinte profesionales (95%) refirieron que el protocolo ARPA aumentaba su carga de trabajo pero consideraron que se debía seguir aplicando. CONCLUSIONES: El tratamiento de pacientes CI directamente en el escáner o en la sala de angiografía incorporando un enfermero de la UI reduce, de forma segura, los tiempos de reperfusión.