stroke
DESCRIPTION
Stroke. Implementing NICE guidance. 2008. NICE clinical guideline 68. What this presentation covers. Introduction Scope Key priorities for implementation Costs and savings Discussion Find out more. Introduction. Stroke is a major health problem in the UK Each year in England: - PowerPoint PPT PresentationTRANSCRIPT
What this presentation covers
Introduction
Scope
Key priorities for implementation
Costs and savings
Discussion
Find out more
Introduction
Stroke is a major health problem in the UK
Each year in England:• 110,000 people have a first or recurrent stroke• a further 25,000 people have a TIA
Over 900,000 people are living with the effects of stroke
Estimated annual cost of stroke is around £7 billion
Scope
The guideline covers the initial care of people over 16 years with TIA or completed stroke
It gives recommendations for:• primary and secondary healthcare settings, including
referral to tertiary care • pre-hospital emergency care settings, including
ambulance services
Key priorities for implementation
•Rapid recognition of symptoms and diagnosis
•Specialist care for people with acute stroke
•Nutrition and hydration
Rapid recognition of symptoms and diagnosis
Reproduced with permission from The Stroke Association
• Use the FAST tool to screen for stroke or TIA outside hospital
Rapid recognition of symptoms and diagnosis
• Ensure that people who have had a suspected TIA who are at high risk of stroke (ABCD2 score of 4 or above) have:
– aspirin (300 mg) started immediately– specialist assessment and investigation within 24
hours of symptom onset– measures for secondary prevention introduced
• Treat all people with crescendo TIA as being at high risk of stroke
Specialist care for peoplewith acute stroke (1)
• Admit anyone with a suspected stroke directly to a specialist acute stroke unit following initial assessment, from the community or from A&E
Specialist care for peoplewith acute stroke (2)
• Perform brain imaging immediately if any of these apply:
- indications for thrombolysis or early anticoagulation treatment
- on anticoagulant treatment
- a known bleeding tendency
- a depressed level of consciousness
- unexplained progressive or fluctuating symptoms
- papilloedema, neck stiffness or fever
- severe headache at onset of stroke symptoms• Otherwise brain imaging should be performed as soon as possible
Specialist care for peoplewith acute stroke (3)
• Thrombolysis with alteplase:
– administer within a well-organised stroke service
– may be used in A&E with appropriate training and support
– protocols should be in place for delivery and management of thrombolysis
Nutrition and hydration
• Screen swallowing on admission before giving any oral food, fluid or medication
Costs and savings
The guideline on stroke is likely to result in a significant change in resource use in the NHS:
• assessment of people who have had a suspected transient ischaemic attack (TIA), and
identifying those at high risk of stroke• magnetic resonance imaging for people who
have had a suspected TIA• referral for carotid endarterectomy• admission to a specialist stroke unit• performing brain imaging immediately where
indicated for people with acute stroke.
For discussionHow do you assess staff competence in the use of methods for rapid recognition of symptoms of stroke or TIA?
How can you ensure that staff are aware of the benefits of providing emergency care for a patient with a stroke or TIA?
How can you ensure that the imaging recommendations are followed 24 hours a day?
What systems do you have in place to ensure there are enough trained staff to provide a swallowing test on admission?
Find out more
Visit www.nice.org.uk/CG068 for:
•Other guideline formats•Costing report and template•Audit support