We recently had an event where a full 50-mg tenecteplase vial was administered to a stroke patient. The root cause was that the nurse followed the dosing chart on the box, which is intended for the STEMI indication only.

Although tenecteplase is FDA approved for STEMI only, many hospitals are using it for stroke, which is endorsed by AHA/ASA guidelines.

Do your sites allow pharmacists to be the independent double-check at the bedside to support nursing? We received this specific question for tenecteplase used in stroke alerts, but other meds have come up as well. Our primary concern is that administration is not in the pharmacist scope of practice for most medications. We also have concerns of a pharmacist cross-checking their own work. However, we recognize that the pharmacist is already at the bedside and very capable to support tenecteplase dosing. Thanks in advance.

I recently found that our facility has an admission policy saying that any patient given tenecteplase or alteplase needs to stay in the ICU for 12hrs and 24 hrs respectively. I can't find any data that those time periods are required. Alteplase does have specific monitoring parameters for 24 hrs but nothing on ICU length of stay. What do others have for guidelines for ICU length of stay if given these? I'm also curious if others are requiring neuro checks x 24 hrs for these medications for all indications, except line clots?