ACute STROKE CARE
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Acute STROKE Care
Acute care is where the person is stabilized, diagnosis confirmed, plans are implemented to prevent complications, and when initial rehabilitation and recovery begin.
Acute Stroke Care refers to the key interventions involved in the assessment, treatment or management, and early recovery in the first days after stroke onset.
The primary aims of the acute phase of care are to identify the nature and mechanism of stroke, prevent further complications, promote early recovery and in the case of the severest strokes provide end-of-life care. Secondary prevention plans and engagement with patients and family to transition to the next level of care is undertaken.
Working Together with Stroke Survivors and their Caregivers to Achieve Optimal Outcomes is imperative across stroke systems of care, with the participation of individuals with stroke, their families and caregivers, healthcare providers, and the broader community. The primary underpinnings of ‘acute inpatient stroke care’ are to optimize recovery and patient outcomes (Canadian Best Practice Recommendations, October 2015)
Acute Inpatient Stroke Care
Achieving optimal outcomes for stroke survivors requires patients to be cared for on dedicated inpatient stroke units by healthcare team members with specialized stroke training, and establishment of evidence-based stroke protocols for all aspects of stroke care, including team meetings with case reviews, and early access to rehabilitation assessments and therapies. Hospitals that manage stroke patients and currently do not have dedicated stroke units should strive to implement all the core elements of stroke unit care, regardless of whether there is a designated stroke unit, and at least cluster stroke patients within a consistent area of a hospital ward and provide staff with education and skills training specific to stroke care. In hospitals where this goal is not possible within, acute stroke patients should be transferred to the nearest hospital that does provide acute stroke unit care. (Canadian Best Practice Recommendations, October 2015)
THE CANADIAN STROKE BEST PRACTICE RECOMMENDATION (CSBPR) IN ACUTE STROKE CARE
The Canadian Best Practice Recommendations (CSBPR) is intended to provide up-to-date evidence based guidelines for the prevention and management of stroke, and to promote optimal recovery and reintegration for people who have experienced stroke (patients, families and informal caregivers).
They are updated and released every 2 to 3 years with interim updates of specific topics when critical new evidence emerges.
They address the continuum of stroke care from stroke symptom onset through the hyperacute period to rehabilitation and longer-term recovery.
The target audience for the CSBPRs includes all healthcare professionals involved in the care of patients with stroke or TIA across the continuum.
According to the CSBPR: "Broadly speaking “acute care” refers to the first days to weeks of inpatient treatment with stroke survivors transitioning from this level of care to either inpatient rehabilitation, community based rehabilitation services, home (with or without support services), continuing care, or palliative care. This acute phase of care is usually considered to have ended either at the time of acute stroke unit discharge or by 30 days of hospital admission". www.strokebestpractices.ca
To visit the acute stroke management best practice recommendation website click here
Acute Best Practice Update: 2018 update to guidelines for healthcare providers caring for people with current or recent symptoms of acute stroke or TIA
To read the full update please click on link below:
Acute Inpatient Stroke Care
Stroke Unit Toolkit:
- It has been found that stroke patients who receive care on a specialized stroke unit have an increased likelihood of survival, return to the home, and independence post stroke (Casaubon et al., 2015). In the Fall of 2014, a provincial integrated working group was formed to develop a stroke unit toolkit. The aim of this toolkit was to provide organizations with a resource that would assist centres with the development and improvement of new and or existing stroke units.
- To access the stroke unit toolkit click on link below:
- For more information and other resources surrounding the Tool Kit please visit the CorHealth website here
Neurological Assessments and Observations:
A neurological (neuro) assessment provides a standardized method to rapidly identify emerging stroke complications, and will provide a better patient prognosis. Symptoms of change in neurological status may include:
- Change in balance
- Decline in motor strength
- Change in speech/language
- Decrease in Coordination
- Pupil changes
- Severe headache
- Change in vision
Reference: (HSFO, Faaast FAQS, 2007)
Background/Info on Stroke Scale:
- The use of a stroke scale in the assessment of the acute stroke patient has been established as best practice stroke care. The Canadian Stroke Best Practice Recommendations (CSBPR, update 2015) state: "A neurological examination should be conducted to determine focal neurological deficits and assess stroke severity [Evidence Level B]. A standardized stroke scale should be used, such as the National Institutes of Health Stroke Scale (NIHSS) or the Canadian Neurological Scale (CNS) (page 2)"
- The NIHSS is a proven, reliable and valid tool in the assessment of the acute stroke patient and has become more common in influencing decisions for treatment options for stroke patients in the acute setting (i.e. thrombolysis therapy).
- Within the West GTA Stroke Network region, hospital sites are either currently utilizing the NIH Stroke Scale or they are in the process of implementing the scale. As an aside, some Emergency departments within the region utilize a modified version and the in-patient units utilize the full version.
Training Options/Resources NIHSS:
- The NIHSS does not require certification to be used in practice, but education and training is required to attain and maintain competence in using the scale and interpreting the score. (CSBPR, Table 3.1)
“Healthcare professionals using the NIH Stroke Scale as a diagnostic tool on patients must show and document proper competency on the use of the tool. Before using the NIHSS it is important to ensure that all health care professionals are following the standards for training and certification program”. This can be found at www.NIHStrokeScale.org (pocket guide).
- Apex Innovations - Online NIH Stroke Scale Learning Module
- Within the West GTA Stroke Network region please be sure to reach out to your educators regarding the NIH Stroke Scale and specific instructions with a keycode on how to register for the free online course.
- NIH Stroke Scale International
- Canadian Stroke Best Practice - Stroke Assess and Prevention Pocket Guide
- Includes, common signs and symptoms, types of stroke, Canadian Neurological Scale, NIH Stroke Scale, FAST signs
Glasgow Coma Scale:
- The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the state of a person's consciousness. The GCS should be completed if you are unable to complete an acute neurological scale, such as the NIH Stroke Scale (NIHSS), due to a decreased level of consciousness.
- Directions on how to complete the GCS can be found here
Please refer to the Canadian Stroke Best Practice Recommendations
Most organizations within the West GTA Stroke Network have adapted to use the STAND tool as the dysphagia screening tool for stroke patients. Please refer to your organization specific validated screening tool.
Only complete the screen if you have been trained! If not trained, contact a Speech and Language Pathologist (SLP).
- The swallowing screen should be completed prior to any oral medications, nutrition or hydration is administered.
- Patients should remain NPO until screen is completed and passed.
- Copy of the original STAND Tool below:
- Below is an excellent document that an SLP within our region created regarding Oral Care which includes some great tips and tools!
- oral care handout
Consult Speech Language Pathologist (SLP) for strategies on how to communicate with a patient with communication difficulties.
- Aphasia (disorder that affects your ability to speak, read, write and understand)
- Receptive Aphasia (saying words that don't make sense)
- Expressive Aphasia (difficulty forming and understanding complete sentences)
- Global (difficulty forming and understanding words and sentences)
- Apraxia (difficulty initiating and executing voluntary movement patterns necessary to produce speech)
- Dysarthria (speech disorder that is characterized by poor articulation, respiration, and/or phonation. This includes slurred, slow, effortful, and rhythmically abnormal speech).
- Aphasia Institute: The Aphasia Institute is a Canadian community-based centre of excellence, pioneering programs and practices that help people with aphasia learn how to communicate in new ways, and begin to navigate their own lives again. Through direct service, research, education and training, the Aphasia Institute has built a reputation as a world leader and educator in aphasia. To access there resources click here.
Upper Extremity Treatment Post Stroke Resources:
- This document was created to aid with transfer of accountability of stroke patients that are being repatriated back to their "home hospital." The receiving hospitals will use this as part of already existing reporting sheet to ensure they have all the appropriate stroke related information.
Clinical Resources - Acute Stroke Care
Please note this section refers to other clinical resources that are not already embedded in specific other sections located in the hyper-acute stroke section of this website that may be useful to you. Should you be looking for something specific please ensure you go to the outlined section if not there please send an e-mail to the key contact person outlined below.
Professional Stoke Education Inventory:
- The Ontario Stroke Network (now part of CorHealth Ontario) created this online resource in collaboration with its stakeholders from across the province. The Professional Stroke Education Inventory includes education resources and implementation tools to support the healthcare providers in clinical practice.
- To access the resource click here!
Core Competencies for Stroke:
- Core Competencies of stroke care are the key clinical skills and knowledge required to enable a healthcare provider to practice at a level consistent with evidence-based stroke care. A framework has been created to support the healthcare provider acquire the education and skills to achieve a level of stroke clinical expertise. The framework includes learning objectives, resources/knowledge translation tools, and suggested evaluation methods.
- To access the resource click here!
Stroke Quality Based Procedures Resource Center:
- Stroke was selected as one of the first Quality Based Procedure medical conditions to be implemented and the Ontario Stroke Network helped in the leading of the implementation.
- The Ontario Stroke Network worked closely with Health Quality Ontario, the Ministry of Health and Long Term Care and clinical experts to develop the Quality Based Procedures: Clinical Handbook for Stroke (Acute and Post-Acute).
- This resource center provides health system planners and clinicians with tools and resources to support implementation of Stroke Quality Based Procedures across the care continuum.
- To access the resource click here!
Stroke Best Practice Pocket Assessment Guide:
- Stroke Assessment and Prevention Pocket Guide - Heart and Stroke
- This resource outlines common signs and symptoms, types of stroke, Canadian Neurological Scale, NIH Stroke Scale, FAST signs
Stroke Engine Acute Stroke Assessment:
Stroke Engine Acute Stroke Interventions:
HOT TOPICS IN ACUTE STROKE CARE
Additional Resources for information about heart disease, stroke and healthy living:
COMMUNITY RESOURCE BOOK Spring 2020 EDITION
- Check out the West GTA Stroke Network's Community Stroke Resource book (updated Spring 2020). The Community Stroke Resource Book provides stroke survivors, caregivers and healthcare professionals with information on:
- Home support services
- Specific regional stroke programs and other community services
- Books, links and other stroke websites
- To access the community resource booklet please go to homepage and click on the following icon