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

● any continuing specialist treatment
required will be provided without delay by
an appropriate coordinated, specialist
multidisciplinary service
● patients and carers are given information
about and offered contact with appropriate
statutory and voluntary agencies.
Quality improvement (governance, audit)
(3.9.1)
B Clinicians in all settings should participate in
national stroke audit so that they can compare
the clinical and organisational quality of their
services against national data and use the
results to plan and deliver service
improvements.
Service development (3.10.1)
A The views of stroke patients and their carers
should be considered when evaluating a
service; one method that should be used is to
ask about their experiences and which specific
aspects of a service need improvement.
End-of-life (palliative) care (3.15.1)
E After stroke, all end-of-life decisions to
withhold or withdraw life-prolonging
treatments (including artificial nutrition and
hydration) should be in the best interests of the
patient and take prior directives into
consideration (see section 6.45).
Treatments not mentioned in the
guideline (3.16.1)
A Any clinician wishing to use an intervention
not considered within this guideline should:
● investigate and review the available
evidence, especially the risks and
disadvantages
● investigate whether there are any relevant
clinical trials available to take part in locally
● offer the patient (or his or her
representative if s/he is unable to
participate in decision-making)
Nutrition and dietetics concise guide for stroke 2012
information about any research study
available, and arrange for entry to the trial
if the patient agrees
● discuss with the patient (or his or her
representative if s/he is unable to
participate in decision-making) the risks
and benefits of the intervention so that an
informed choice can be made.
B Interventions not considered within this
guideline may be used provided that:
● any available opportunity for participation
in evaluative research has been considered
● the clinician or clinical team has the
appropriate knowledge and skill
● the patient (or his or her representative if
s/he is unable to participate in decisionmaking)
is aware of the lack of evidence,
and the perceived risks and benefits.
Early phase medical care of stroke –
physiological monitoring and
maintenance of homeostasis (4.12.1)
B The patient’s physiological state should be
monitored closely to include:
● nourishment and hydration.
Initial, early rehabilitation assessment
(4.13.1)
A All patients should be assessed within a
maximum of 4 hours of admission for their:
● ability to swallow, using a validated swallow
screening test (eg 50 ml water swallow)
administered by an appropriately trained
person
● nutritional status and hydration.
Nutrition: feeding, swallowing and
hydration (4.17.1)
A Patients with acute stroke should have their
swallowing screened, using a validated
screening tool, by a trained healthcare
professional within 4 hours of admission to
hospital, before being given any oral food, fluid
or medication, and they should have an
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Nutrition and dietetics concise guide for stroke 2012