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Stroke

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:

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Stroke

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  1. Stroke Implementing NICE guidance 2008 NICE clinical guideline 68

  2. What this presentation covers • Introduction • Scope • Key priorities for implementation • Costs and savings • Discussion • Find out more

  3. 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

  4. 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

  5. Key priorities for implementation • Rapid recognition of symptoms and diagnosis • Specialist care for people with acute stroke • Nutrition and hydration

  6. Rapid recognition of symptoms and diagnosis • Use the FAST tool to screen for stroke or TIA outside hospital Reproduced with permission from The Stroke Association

  7. 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

  8. 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

  9. 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

  10. 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

  11. Nutrition and hydration • Screen swallowing on admission before giving any oral food, fluid or medication

  12. 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.

  13. For discussion • How 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?

  14. Find out more • Visit www.nice.org.uk/CG068 for: • Other guideline formats • Costing report and template • Audit support

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