Saudi Stroke Standards

End of Life Care Purpose Stroke is one of the leading causes of death and disability; 1 in 20 patients die within 72 hours following admission and 1 in 7 of stroke patients will die in hospital. Furthermore 20% of stroke sufferers die within 30 days of a stroke. People who are not likely to recover from their stroke and at risk of dying should receive care at the end of their lives in hospital or the community. This should take account of their needs and choices and is delivered by a workforce with appropriate skills and experience in all care settings. Rationale  Providing high-quality end-of-life care to stroke patients can be challenging and requires a skilled and experienced workforce.  Deciding when it might be more appropriate for someone who has had a stroke to receive end-of-life care rather than active rehabilitation and providing such care when communication is difficult is a considerable challenge and requires skilled decision-making and interaction from an experienced workforce.  The needs and wishes of both the patient and their family, if appropriate, should be considered as part of this process and should be reviewed regularly to ensure that their needs continue to be met throughout the last phase of life and into bereavement. This includes the management of pain and other symptoms, and the provision of psychological, social, spiritual and practical support.  People in need of this care will often already be in hospital, but they may also be at home, in care homes or other care settings. Standards 1. Patients with stroke who are reaching end of life need to be identified and referred to palliative care in the hospital or the community. 2. Holistic approach to be taken to manage the patient’s physical and psychological symptoms and will identify family needs and support during this period. 3. Acute stroke patients should be referred to palliative care specialists if they meet three out of the four conditions on day three of being in coma below: i. Abnormal brainstem response ii. Absent verbal response iii. Absent withdrawal response to pain iv. Serum creatinine more than 1.5gm/dl 4. Chronic stroke patients should be referred to palliative care if they meet one of the following criteria: i. If the rating on Karnofsky performance scale is less than 50% or, ii. If the score of less than 40% is achieved on palliative performance scale, or iii. If weight loss of more than 10% is observed in the last six months or, iv. If weight loss of more than 7.5% is observed in the last three months or, v. If serum albumin is less than 2.5gm/dl or, vi. If there is current history of pulmonary aspiration not responsive to SLP intervention or, vii. If there is sequential calorie count documenting inadequate calorific intake.25 25 AHA guidelines 5. All the patients meeting criteria for palliative care should be transferred to palliative care team within 24 hours of assessment. Chapter 6. Human resource development Objective  To improve capacity and capability among the organizations providing stroke care  To ensure quality and safety of patient care  To increase productivity and efficiency  To improve the work environment Key facts  Human resources development (HRD) decisions are known to be associated with patient outcomes.  Increased staffing or skill mix is related to key clinical outcomes, such as, lower infection rates, increased probability of survival and better continuum of care indicators.  Other aspects of HRD, including strategic planning and training and development, have been found to relate to a reduction in medical errors.  HRD can impact on patient care by influencing how professionals apply their technical knowledge and skills, and their relationships with patients. Introduction Human resources standards refer to the minimum and appropriate mix of human resources that is required to serve the expected populations at the different levels of the system, with the defined health services, to ensure comprehensive health service delivery in an efficient, equitable and sustainable manner. All of the elements of a stroke system of care will operate in a highly complex and multidisciplinary environment, with many elements and stakeholders, each with their own rules and regulations. In terms of the many controlling authorities, it is paramount that the “best interests of the patient” be the primary concern and driving factor when any rules and regulations are made and implemented. The Acute Stroke Ready Hospitals (ASRH), Primary Stroke Hospital (PSH) and comprehensive Stroke Hospital (CSH) should also provide education to its employees, regional healthcare providers, EMS, and lay groups. Public education should focus on stroke risk factors (screenings for hypertension and other risk factors), as well as the recognition of acute stroke symptoms. A minimum of 2 professional and 2 public programs each year are suggested. These programs should be integrated across the spectrum of care within a stroke system. QM