Thrombolysis for acute ischaemic stroke: the development of a nurse protocol in the United Kingdom

This paper describes a nursing protocol for patients treated with thrombolysis for acute ischaemic stroke developed during the Stroke Association phase of the Third International Stroke Trial (IST-3), a randomised controlled trial of recombinant tissue plasminogen activator for acute ischaemic stoke. The IST-3 Nurse collaborative group met three times over three years. The meetings consisted of educational updates on stroke thrombolysis, training on trial procedures, presentations by participating nurses and discussions of good practice, local initiatives and sharing common problems. Lack of knowledge, fear of bleeding complications and lack of appropriate NHS beds were common barriers. Core nursing requirements suggested by this research included: fast-tracking of patients; access to trained stroke physicians; acute physiological monitoring and nursing intervention; effective communication and support of patients and carers; knowledge of complications and actions to be taken; transfer to an appropriately skilled stroke unit environment and successful discharge planning to home or rehabilitation.