national-clinical-guidelines-for-stroke-fourth-edition

Recommendations

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● where appropriate refer the person with stroke on to community organisations (statutory and non-statutory) that can support the patient in fulfilling their wanted roles. B Local commissioners should ensure that community integration and participation for disabled people is facilitated through: 7.3.2 Sources ● ensuring a suitable community transport system that is accessible and available ● organising and supporting venues for social and leisure activities able to accommodate disabled people, especially people with communication and cognitive problems ● organising and supporting social networks for disabled people (eg through voluntary groups) ● making sure appropriate stroke specialist and generic voluntary sector services and peer support (eg communication support groups, stroke clubs, self-help groups and communication partner schemes) are available and that information and signposting to them are given. A–B Consensus; National Stroke Strategy quality markers 13 and 15 7.4 Support (practical and emotional) Many people need considerable care from others after stroke, both for personal activities such as washing and dressing, and more so for domestic and community activities. Provision of this support is rarely the responsibility of the healthcare system, but healthcare teams do have a responsibility to identify and specify the support needs of each patient, and to help organise this support from the responsible organisations. Evidence to recommendations There is evidence of unmet need in nearly 50% of stroke survivors, between 1 and 5 years after stroke. This includes problems related to mobility, falls, fatigue, pain, emotion, memory, reading and concentration (McKevitt et al 2011). Services should ensure that mechanisms are in place to identify and address such issues. The research evidence to inform service development and delivery in this area is limited. One approach has been to employ and train healthcare workers or volunteers (eg a stroke liaison worker) to provide education and social support (including counselling) and liaison with services for people with stroke and carers. A meta-analysis of trials of such interventions reported that these were associated with significant reductions in disability and death in patients with mild to moderate disability (Ellis et al 2010). There is no trial evidence that they improve subjective health status or activities of daily living. 7.4.1 Recommendations 7 Long-term management A Patients and their carers should have their individual practical and emotional support needs identified: © Royal College of Physicians 2012 127
National clinical guideline for stroke ● before they leave hospital ● when rehabilitation ends or at their 6-month review ● annually thereafter. B Health and social services personnel should ensure that: ● any identified support needs are met ● support services appropriate to the needs of the patient and carers are provided ● patients are informed about organisations able to provide other relevant services, and how to contact them ● patients and carers receive all the financial and practical support to which they are entitled. C Patients should be provided with information tailored to their own specific needs regularly during the acute, rehabilitation and longer-term care phases of the illness. 7.4.2 Sources A Consensus; National Stroke Strategy quality marker 13: ‘A range of services are in place and easily accessible to support the individual long-term needs of individuals and their carers’ B Consensus; National Stroke Strategy C Consensus; National Stroke Strategy; McKevitt et al 2011; Ireland 2009 7.5 People with stroke in care homes Between 5% and 15% of patients are discharged into care homes and, conversely, about 25% of care home residents have had a stroke. At present these people rarely receive any treatment from rehabilitation services; indeed, care home residents are not even provided with standard wheelchairs by the NHS. These are usually the most severely affected people and therefore those most likely to need treatment and support. Improving the quality of life of people with stroke in care homes should be an integral component of all stroke services and include active management of their impairments, abilities and participation. 7.5.1 Recommendations A All people with stroke in care homes should receive assessment and treatment from stroke rehabilitation services in the same way as patients living in their own homes. B All staff in care homes should have training on the physical, psychological and social effects of stroke and the optimal management of common impairments and activity limitations. 7.5.2 Sources A Consensus; Sackley et al 2006 B Consensus; National Stroke Strategy quality markers 18 and 19: ‘All people with stroke, and at risk of stroke, receive care from staff with the skills, competence and 128 © Royal College of Physicians 2012
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National clinical guideline for str
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The Royal College of Physicians The
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The Intercollegiate Stroke Working
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Conflicts of interest All working p
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Key recommendations Number Recommen
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Acknowledgements The Intercollegiat
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Glossary ABCD2 score Prognostic sco
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2 Commissioning of stroke services
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2.1.2 Implications needed by patien
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2.4 Commissioning rehabilitation se
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3 Organisation of stroke services 3
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symptoms who screen positive using
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● nursing staff specifically trai
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3.5.1 Recommendation 3.5.2 Source A
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3.8 Transfers of care - discharge f
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B Clinicians in all settings should
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E have protocols to guide the use o
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Evidence to recommendations It is r
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evidence from randomised trials is
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4 Acute phase care 4.0 Introduction
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E All patients with residual neurol
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esources to respond to the need. Pr
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D People with an acute non-disablin
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D Consensus; quality marker eight o
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[K] Any person with acute ischaemic
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prevent rebleeding are urgent. CT s
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anticoagulants including direct thr
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Evidence to recommendations Studies
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● risk of developing skin pressur
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4.16 Positioning Impairment of moto
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section covers only the immediate,
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● organising and supporting venue
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Appendix 1 Evidence table reviewers
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Appendix 2 Peer reviewers Commissio
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Dr Katerina Hilari City University
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QM7 Urgent response All patients wi
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References Abbott AL (2009) Medical
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Cirstea MC, Levin MF (2007) Improve
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Fung TT, Chiuve SE, McCullough ML,
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Koyuncu E, Nakipoglu YG, Dogan A, O
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Mitchell PH, Veith RC, Becker KJ, B
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Rothwell P, Eliasziw M, Gutnikov S,
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therapy for stroke inpatients. Clin
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