The purpose of this National Working Group is to develop and implement a strategy that supports provision of a stroke thrombolysis service in all large and medium sized DHBs using clearly documented protocols and quality assurance measures.
For small DHBs it is expected a thrombolysis service is provided or a timely, effective pathway to access a service elsewhere.
Thrombolysis Working Group
The Thrombolysis Working Group has agreed the following:
- All DHBs should provide access to 24/7 stroke thrombolysis either via trained local staff or assistance from a larger centre.
- A national protocol template is desirable and two sub-groups have been formed to work on a pre-hospital pathway and an in-hospital pathway.
Minimum quality assurance requirements were agreed:
- That treating physicians should have completed either formal thrombolysis training as part of a training scheme or completed post-qualification training (three months)
Have attended a thrombolysis training course and have access to expert back-up when making treatment decisions
- All services should undergo regular clinician attended case review sessions with discussion of all post-thrombolysis bleeds and deaths at a minimum
- All services should keep a registry of all patients thombolysed recording:
- Door to needle time
- Door to CT time
- Post-thrombolysis CT findings
- Post-thrombolysis vital status, and
- Pre and post level of functioning (ideally NIHSS score).
Use of the SITS registry is suggested but further review is required before routinely recommending this registry.
Links to thrombolysis education and resources:
i. STARS Web-based Thrombolysis Masterclass Modules:http://www.strokeadvancingmodules.org/labyrinth_thrombo/
ii. Complete NIHSS Certification http://nihss-englidh.trainingcampus.ne/uas/modules/trees/windex.aspx
iii. World Stroke Academy – Hyper-acute Stroke course (free)
iv. Acute Stroke Online (AHA) – (8 hour - US$24.95) http://www.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/Stroke/Acute-Stroke-Online_UCM_307440_Article.jsp