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

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Carers (informal, unpaid) (7.6.1) A At all times the views of the patient on the involvement of their carers should be sought, to establish if possible the extent to which the patient wants family members and others involved. F After the patient has returned to the home (or care home) setting, the carer should: ● have their need for information and support reassessed whenever there is a significant change in circumstances (eg if the health of either the patient or the carer deteriorates) ● be reminded and assisted to seek further help and support. Contacts Nursing concise guide for stroke 2012 Ms Amanda Jones, stroke nurse consultant, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF Email: amanda.jones@sth.nhs.uk Mrs Diana Day, stroke nurse consultant, Addenbrooke’s Hospital, Cambridge, CB2 0QQ Email: diana.day@addenbrookes.nhs.uk Dr Christopher Burton, senior research fellow in evidence based practice, Centre for Health Related Research, College of Health and Behavioural Sciences, Bangor University, Gwynedd, LL57 2EF Email: c.burton@bangor.ac.uk © Royal College of Physicians 2012 139 Nursing concise guide for stroke 2012
Nutrition and dietetics concise guide for stroke 2012 Nutrition and dietetics concise guide for stroke 2012 These profession-specific concise guidelines contain recommendations extracted from the National clinical guideline for stroke, 4th edition, which contains over 300 recommendations covering almost every aspect of stroke management. The recommendations for each profession are given with their numbers, so that they can be found in the main guideline. The recommendations below have direct implications for dietitians. These should not be read in isolation and as members of the stroke multidisciplinary team, dietitians should consider the guideline in full. Structure – global cover (2.1.1) C Commissioners need to be satisfied that all those caring for stroke patients have the required knowledge and skills to provide safe care for those with restricted mobility, sensory loss, impaired communication and neuropsychological impairments. Commissioning secondary prevention services (2.3.1) B Commissioners should commission acute hospital health services to: ● identify and initiate treatment for all treatable risk factors as soon as possible ● give all patients written information and advice on lifestyle changes that reduce the risk of stroke, tailored to the needs of the individual person ● liaise with general practitioners about the long-term management of any identified risk factors for each patient. C Commissioners should facilitate the lifestyle recommendations made through: ● supporting smoking cessation ● working with other organisations to make it easier for people with disability to participate in exercise ● supporting healthy eating ● supporting those with an alcohol problem to abstain or maintain their intake within recommended limits. Specialist stroke services (3.2.1) E Patients with acute stroke should have their swallowing screened, using a validated screening tool, by a specially trained healthcare professional within 4 hours of admission to hospital, before being given any oral food, fluid or medication, and they should have an ongoing management plan for the provision of adequate nutrition. Resources (3.3.1) B Each stroke rehabilitation unit and service should be organised as a single team of staff with specialist knowledge and experience of stroke and neurological rehabilitation including: ● dietitians. Transfers of care – discharge from hospital (3.8.1) B Hospital services should have a protocol, locally negotiated, to ensure that before discharge occurs: ● patients and carers are prepared, and have been fully involved in planning discharge ● general practitioners, primary healthcare teams and social services departments (adult services) are all informed before, or at the time of, discharge ● all equipment and support services necessary for a safe discharge are in place 140 © 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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Page 158 and 159: C People with stroke should be offe
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Page 192 and 193: Depression and anxiety (6.35.1) A A
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Page 204 and 205: Appendix 1 Evidence table reviewers
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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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