A review of barriers to thrombolytic therapy: implications for nursing care in the emergency department.

Despite stroke being the third leading cause of death and a leading cause of disability in the United States, less than 7% of stroke survivors receive tissue plasminogen activator (tPA) in the treatment of acute stroke. The purpose of this review was to determine what research is available on barriers to tPA use and to determine gaps in the literature. A search of the literature was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed. Keywords were stroke, emergency, nursing, thrombolytics, cerebrovascular accident, ischemia, intervention, tPA, and barriers. Pertinent references from articles obtained were searched as well. The search yielded 45 articles for review. Barriers to tPA use were found in both prehospital and in-hospital settings. Prehospital delays were related to contacting primary care physicians, mode of arrival to the hospital, and survivors' lack of knowledge regarding stroke. Sources of in-hospital delays included non-stroke center status, lack of training of emergency department staff, delays in computed tomography scans, and poor understanding regarding priority stroke treatment (e.g., mild or improving symptoms and disparities related to age, gender, and race). Future research to evaluate the impact of nursing care and attitudes toward stroke patients on the administration of tPA is recommended.