Objective:

To determine factors involved in delay of aspirin administration in patients, who are evaluated after stroke code activation and are not candidates for IV t-PA or MT pre- and post-COVID pandemic.

Background:

Majority of patients, who are evaluated in emergency department (ED) after stroke code activation are not candidates for IV- t-PA or MT. Such patients can be candidates for aspirin as secondary stroke prevention. Ordering and administering aspirin is, sometimes, delayed due to various factors, which leads to delay in care of patients. Assessing and addressing these factors are paramount in timely administration of aspirin.

Design/Methods:

This is a retrospective chart review and quality improvement project.
The approval from institutional IRB was obtained.

Results:

EMR of 264 patients (105 patients in 62 days pre-COVID; 159 patients in 120 days post COVID) was reviewed. 153 patients (57 pre-COVID, 96 post-COVID) were excluded as they were not candidates for aspirin (on anticoagulant = 31; intracranial hemorrhage = 28; initial presentation seizures = 26 and others = 68). 111 patients (48 pre-COVID, 63 post-COVID) were included in analysis. Demographics of included patients were: average age = 62.1 (range: 23-94) years, male = 49, female = 62. Average interval between stroke code activation and aspirin ordered by healthcare provider (HCP) was 191 minutes pre-COVID and 165 minutes post-COVID pandemic. Average interval between aspirin ordered by HCP and administered by nursing staff was 295 minutes pre-COVID and 255 minutes post-COVID pandemic.

Conclusions:

Delay in ordering and administering aspirin was seen in pre- as well as post-COVID pandemic. Delay in administering aspirin by nursing staff was primarily due to failure to order aspirin STAT and erroneously keeping patient nothing per oral by HCP. Proper education of HCP and nursing staff is paramount for timely and correctly ordering, and administering aspirin and hence to improve quality of care to patients.