Abstract A117: Feasibility of Implementation of Low Intensity Monitoring Pathway in Patients Receiving Intravenous Thrombolysis Therapy

Background: American Heart Association (AHA) guidelines recommend intensive monitoring of patients who receive intravenous (IV) thrombolysis which places significant strain on nursing staff and hospital resources. The OPTIMISTmain trial demonstrated the non-inferiority of low-Intensity monitoring in a select patient population who receive IV thrombolysis. We sought to demonstrate the feasibility of Low Intensity monitoring Protocol (LIMP) for patients with post IV thrombolysis in community practice. Methods: We designed LIMP as a standard pathway for patients admitted post IV thrombolysis with acute ischemic stroke with a baseline NIHSS ≤6 and did not have clinical deterioration or require IV antihypertensive therapy within the first 12 hours. The LIMP pathway was initiated at 12 hours post-thrombolysis and includes vital sign assessment every 4 hours and NIHSS evaluations every 2 hours from 12 to 24 hours. Eligible patients were transferred to the telemetry stroke unit when beds were available; otherwise, they remained in the ICU but were monitored at the reduced frequency. All stroke patients received standard of care per current AHA guidelines for the first 12 hours. Patients not meeting LIMP criteria remained in the ICU and continued the AHA recommended monitoring for 12-24 hours, including hourly neurological assessment and blood pressure monitoring. Implementation: The current AHA guidelines and evolving literature showing safety of LIMP were presented to the nursing leadership and administrators. Following review and agreement, the LIMP pathway was presented at the stroke committee meeting for multidisciplinary input and approval. Educational sessions were conducted with ICU/stroke telemetry department leadership, stroke champions, and bedside nurses. After consensus was reached, targeted education and training were rolled out to frontline staff across the participating units to support implementation of LIMP pathway. Results: From August 2022 to April 2025, 41 patients were monitored using LIMP. The mean admission NIHSS was 2.83 (SD ±1.82). No patients required ICU readmission, initiation of IV antihypertensive therapy, or escalation due to neurological deterioration. Conclusion: The LIMP pathway utilization is feasible and appears to be safe in patients with mild to moderate stroke who received IV thrombolysis. Adoption was facilitated through a collaborative, consensus-building process with hospital administration, stroke leadership, and nursing staff.