north gwent acute stroke service our progress so far ………
TRANSCRIPT
North Gwent Acute Stroke Service
Our Progress So Far ………
Where are we?
North of ‘Gwent Healthcare NHS Trust’
Market Town Of Abergavenny
Where Is Our Stroke Unit?
Based in Nevill Hall Hospital
Acute Stroke Unit
The Acute Stroke Unit Approximately 350 Acute Strokes per year 40 + TIA Referrals/ month so far – seen in a
5-day TIA clinic 22 bedded Acute Stroke Unit and General
Rehabilitation Ward 4 Ring-fenced beds? Direct Admission Policy No exclusion Policy
The Multidisciplinary Team
2 Stroke Consultants 2 CNS Stroke 3 Physiotherapists 1 Occupational Therapist 1 Speech & Language therapist 1 Dietician 2 Rehabilitation Assistants 1 Ward Manager Registered and Unregistered
nursing staff
AWSSIC
First meeting November 2007 Local meetings held every 6-8 weeks Well supported by Michelle Price Motivated MD team Working together on a daily basis Longevity of working relationships
Areas of Weakness Identified Via ….. Audit inc Sentinel Audit Poor bundle success Satisfaction questionnaires Carers clinic Informal complaints Group discussion Bed crisis
Weaknesses Included .. 1.No data collection method
2. Patients weight not clearly documented
3. Lack of dietetic stroke protocols
4. No ‘Time’ on Manual Handling Assessments
Weaknesses continued …. 5. Acute areas not familiar with ROSIER
6. No evidence of information given to carers
7. No Barthel on discharge
8. OT + PT initial assessments not recorded consistently in patient notes
Weaknesses continued ….
9. Assessment + Rehab lacking at weekends
10. No clear Admission Policy to ASU
11. No SLT screening for communication issues in first days bundle
12. Lack of awareness of our work with NLIAH amongst colleagues
What We Did….
Some Simple Solutions Invent a Sticker for Everything!
Solutions 1. Redesigned data collection form and
agreed where to keep it
2. Adapted Ward Transfer Sticker
3. Dietetics – redesigned sticker for notes
4. Added date and times to Manual Handling Assessments
Solutions cont/d… 5. Carried out ROSIER training in acute
areas
6. Introduced a checklist sticker for information packs given to patient/carers
7. Amended Barthel Score Sheet
8. OT & PT introduced Assessment stickers
Solutions cont/d… 9. Two Rehabilitation Assistants and one
qualified physiotherapist to cover weekends
10. Managers and clinicians agreed the ‘Ring fenced bed’ and ‘Direct Admission’ policies
11. Speech and Language Therapist accepting blanket stroke patient referrals
12. CNS provided update sessions on Stroke Developments
Obstacles Encountered
Lack of clerical support Extra work – data collection Low on medical colleagues agenda Physiological monitoring installation delay Staff on leave Keeping all staff on board
SO MUCH ELSE GOING ON!
Benefits So Far ….
Improved bundle success – but could do better
Enhanced patient care inc 7-day Rehab A chance to evaluate and evidence what we
were already doing Strengthening working relationships Promoted stroke service awareness across
the local and wider areas
The End
We are happy to share and discuss anything that may be if interest to you
Thank you