Background
St Vincent’s Hospital, Sydney, has a longstanding commitment to evidence-based stroke care, participating in multiple nursing, allied health and medical stroke trials. Local pre/post analyses from the QASC Australasia Trial1 revealed delays in aspirin administration due to swallow screening requirements, and inappropriate oral administration of medications before receiving a formal swallow screen or after failing a swallow screen. This highlighted a critical gap in hyperacute management of patients with ischemic stroke and suspected dysphagia.
Aim: To collaboratively develop an alternative hospital policy that enabled aspirin administration within the recommended 24 hours of stroke onset for patients unable to receive treatment via the oral route.
Methods: A multidisciplinary working party was established involving speech pathology, emergency department, and pharmacy. The team reviewed existing protocols and developed a revised policy enabling alternative administration routes for aspirin in patients unable to swallow safely. Executive approval and support was sought to implement these changes across the hospital.
Results:
Aspirin has been available from October 2025 for per rectal administration in the hyperacute treatment of patients with suspected dysphagia following ischemic stroke. Since introduction aspirin has been administered rectally 8 times to patients that have failed the ASSIST in the hyper acute stage.
Conclusion: Ongoing involvement in major stroke clinical trials raises awareness of the importance of evidence-based care and has facilitated evidence-informed policy change in a tertiary hospital. Improving access to hyperacute stroke treatment for patients with communication and swallowing impairments has the potential to improve clinical outcomes while maintaining patient safety