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Stroke guidelines are at Primary Care Clinical Practice Guidelines
http://medicine.ucsf.edu/resources/guidelines/guide7.html#cva

Each hospital medical staff can determine who can do what procedure based
upon training and qualifications.  So, it does not necessarily need to be a
 neurologist who orders t-PA as long as the specialists have determine the
 guidelines for starting t-PA.  A physician would have to apply for
privileges to order t-PA just as they would apply for priviledges to treat
acute MI patients in the CCU/ICU..


KAISER Clinical Practice Guidelines for Acute Stroke:
Tissue Plasminogen Activator for Acute Ischemic Stroke (October 1996)
http://www.stroke-site.org/Kaiser/Kaiser-tpa.htm
"4. Neurologist has been consulted (at least by telephone) and concurs with
t-PA use.
Neurology will participate in ongoing inpatient management."
  This would mean that a non-neurologist could give the orders as long as
neurology was consulted.


National Stroke Association  Stroke Center Recommendations
http://www.stroke.org/SCN_Recommendations.html

Operational Recommendations
3.The Center has a designated medical director committed to acute stroke
care
4.The stroke team has the appropriate experience to maintain skill and
proficiency in the care of stroke patients

Organizational Recommendations
The Stroke Center team include a specialist and support in:
           a.  Neurology
           b.  Neurological Surgery
           c.  Neuroradiology
           d.  Emergency Medicine
           e.  Rehabilitation Medicine
The Stroke Center team should include, on an as needed basis, a specialist
and support in:
           a. Primary Care
           b. Cardiology
           c. Vascular Surgery
           d. Internal Medicine
           e. Hematology
           f. Infectious Diseases
           g. Gastroenterology
           h. Pathology
           i. Critical Care


TPA Stroke Study Group Physician's Orders
http://www.stroke-site.org/acute%20stroke%20toolbox/orders.htm
Because time is critical (< 3 hrs), it could be the ER physican who orders
the t-PA:
Emergency Department Orders:  Set Two - Thrombolytic Therapy


More guidelines, pathways and orders at The Brain Attack Coalition
Acute Stroke Toolbox
http://www.stroke-site.org/default.htm


peter sam, web content developer
Primary Care Clinical Practice Guidelines
http://medicine.ucsf.edu/resources/guidelines/
[log in to unmask]  asian health services 818 webster oakland ca


On Wed, 22 Dec 1999 11:53:30 -0800, Owens, Janet : MP Library
<[log in to unmask]> wrote:

>I am looking for community hospital standards/guidelines/policies with
>regard to the administration of t-PA for stroke victims.
>
>Our community hospital established a new stroke unit that currently
requires
>orders from a neurologist for the administration of t-PA for stroke
victims.
>The staff wants to know, now that t-PA has been used for stroke for several
>years now, do any community hospitals have standards or guidelines that DO
>NOT require that the orders come from a neurologist. The stroke unit staff
>members here are thoroughly familiar with the stringent criteria that must
>be met for a victim to be considered a good risk for t-PA.
>
>I've already searched the National Guideline Clearinghouse and Medline.
>
>If you have access to your community hospital's policies on this topic and
>can share them, I would greatly appreciate it.
>
>Thank you.
>
>Janet Owens
>Librarian
>Legacy Meridian Park Hospital
>Tualatin, OR 97062
>503-692-2296