Saudi Stroke Standards

Protocol for acute stroke screening Purpose Acute stroke symptoms are frequently missed in the ED or inpatient area; standardized tools used for screening suspected stroke patients ensures patients enter the stroke pathway quickly and receive appropriate treatment in a timely manner. To ensure that all hospitals have implemented a protocol for acute stroke screening. . To ensure patient safety and accuracy in the treatment plan Rationale  Timely assessment of suspected stroke patients is crucial to enable timely and appropriate therapy.  The duration for obtaining timely brain imaging is crucial for making timely decision for management of stroke patients.  Identification of hypoglycemia that may mimic stroke symptoms, is key to ensure that the patients receive appropriate timely treatment. Standards 1. All hospitals must implement a protocol for acute stroke screening in the ED and inpatient areas. 2. All hospitals must have an immediate triage processes in ED for patients with acute stroke symptoms. 3. Use of a standardized scale for screening and quantifying the impact of stroke is recommended. All patients with stroke symptoms must be evaluated by using a standardized evaluation for stroke assessment tool (FAST). 4. Every patient with FAST positive results must have urgent access to neurological expertise. 5. All patients with acute stroke symptoms must have blood glucose checked. 6. All hospitals treating stroke patients must have a designated stroke team to assess and manage acute stroke. 7. NIHSS is such a standardize scale which quantifies the degree of neurological deficit, facilitates communication between different groups of healthcare providers, assists the decision for reperfusion therapy, and it is an objective measure of clinical outcome. The NIHSS will be used in all hospitals. 8. All patients with acute stroke symptoms will be restricted from having oral intake until they pass the swallowing assessment. See section QM 4.2.4 Swallow screening . 9. ED staff must be trained to detect acute stroke symptoms. 10. IV r-tPA will be given where clinically indicated unless the patient refuses it. QM