Pharmacy resident participation with a 24-hour multidisciplinary stroke response team

Stroke is an increasingly common reason for emergency department (ED) visits in the United States, affecting over 700,000 patients per year.1 It is estimated that 80% of all strokes are ischemic strokes. However, despite the frequency of strokes and their substantial morbidity and mortality, few therapies exist to limit the damage from this devastating diagnosis.1 One agent with Food and Drug Administration-approved labeling for ischemic stroke is i.v. alteplase (recombinant tissue plasminogen activator).1 Current guidelines for this agent recommend its use within the first 3 hours of the onset of stroke symptoms in patients who meet specified criteria.1 Recent data from the European Cooperative Acute Stroke Study III led to an American Heart Association (AHA)–American Stroke Association (ASA) advisory statement recommending the extension of this time frame to 4.5 hours after the onset of symptoms in specific patient populations.2 Despite the success of this therapy, the use of i.v. alteplase is often complicated by complex inclusion and exclusion criteria, bleeding risk, the necessity for intense patient monitoring, the drug’s substantial cost, and the potential for significant medication errors. To assist in alleviating these issues, AHA has recommended the utilization of a multidisciplinary care team and the potential use of specialized stroke units to ensure best practice.3 At the University of Kentucky (UK) Chandler Hospital, a multidisciplinary stroke response team is activated whenever a patient arrives at the ED with signs and symptoms of an ischemic stroke. Since its inception in 1996, the stroke response team at the hospital has incorporated the participation of a clinical pharmacist to aid in assessing a patient’s candidacy to receive thrombolytic therapy for stroke. Participation on this team is provided 24 hours a day via the pharmacy resident on-call system.