Saudi Stroke Standards

Acute stroke unit Purpose 16 Lloyd Jones D et al, Circulation. 2010 17 Lovelock CE et al, Neurology. 2010. To improve stroke patient’s outcomes & reduce mortality by providing multi-disciplinary treatment by specialist clinicians and professionals in the acute phase of stroke. Rationale  Acute stroke and some TIA patients admitted to stroke units have less morbidity and mortality, better functional outcomes and better quality of life.  Acute medical management, discovering the pathophysiology of the stroke and starting secondary stroke prevention measures occurs in the acute stroke unit.  Common comorbidities are prevented by following unified stroke protocols.  Co-ordinated multidisciplinary acute rehabilitation is started in the stroke unit and connects the patient and family to further short- and long-term stroke services.  A multidisciplinary team that consists of physicians, nurses and rehabilitation staff (physiotherapy, occupational therapy, speech therapy), social work, nutrition, psychology and other staff with stroke expertise, manage the patients in a holistic manner. Standards 1. All primary and comprehensive stroke hospitals will have an acute stroke unit (ASU). a. Acute stroke unit is a dedicated location within a hospital where stroke specialist, multidisciplinary management of stroke patients is provided by a dedicated team. b. During the ASU admission: i. An understanding of the stroke patient’s pathophysiology will be established a. Carotid imaging will be performed for anterior circulation strokes in a timely fashion ii. Appropriate acute medical management documented iii. Secondary stroke prevention advice given c. Prewritten protocols and policies will be followed for all stroke and TIA patients i. To prevent deep venous thrombosis ii. For acute antiplatelet/anticoagulant use iii. Discharge medications for antiplatelet/anticoagulants, statins and hypertensive medications iv. Stroke education v. Connection with smoking cessation program vi. Management of blood pressure d. Daily clinical reviews are performed by stroke trained consultants. 2. The majority of stroke and some TIA patients will be admitted to ASUs unless other conditions requiring immediate specialist care elsewhere, dominate. 3. The patient will be assessed by appropriate rehabilitation specialties within 48 hours, and a long-term rehabilitation plan will be developed. 4. All medical staff caring for stroke patients shall be competent in stroke medicine, stroke rehabilitation and stroke nursing (see guidance on staff training - Chapter 6. Human resource development). 5. Appropriate staffing ratios shall be met (see guidance on types of stroke units - Chapter 2. Network). 6. Some stroke units may choose to further divide their unit into acute stroke units, skilled nursing units and rehabilitation stroke units. (see guidance on types of stroke units). 7. Continuous physiological monitoring will be done during the acute phase. 8. All patients admitted with suspected acute stroke have a swallow screening assessment performed on admission, by appropriately trained and competent staff, and a protocol for short- and long-term management of swallowing will be made. 9. All stroke patients should have a nutritional screening assessment performed within 24 hours of admission. A protocol for short- and long-term management of nutrition will be made. 10. Conscious patients admitted with suspected acute stroke are mobilized out of bed on the day of admission. A protocol for early mobilization will be followed. 11. A protocol for the promotion of bladder and bowel continence including a policy to avoid urinary catheters. 12. Multidisciplinary team meeting occurs at least weekly to discuss progress and plan goals for patients as well as timely and appropriate transfers of care. QM