Canadian Best Practice Recommendations for Stroke Care 2006: Recommendations 1

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Canadian Best Practice Recommendations for Stroke
Care 2006 Recommendations 12Public Awareness
ResponsivenessPatient and Caregiver Education
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Canadian Best Practice Recommendations 2006

• 24 recommendations
• Public Awareness (1)
• Patient and Caregiver Education (1)
• Stroke Prevention (7)
• Acute Stroke Management (8)
• Stroke Rehabilitation (6)
• Follow-up and Community Re-engagement (1)

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Cross Continuum Recommendations

• 1.0 Public Awareness
• 1.1 Public Awareness and Responsiveness
• 2.0 Patient and Family
• 2.1 Patient and Caregiver Education

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Prevention

• 3.0 Prevention of Stroke
• 3.1 Lifestyle Management
• 3.2 Blood Pressure Management
• 3.3 Lipid Management
• 3.4 Diabetes Management
• 3.5 Antiplatelet Therapy
• 3.6 Anticoagulation in Atrial Fibrillation
• 3.7 Carotid Intervention

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Acute Stroke

• 4.0 Acute Stroke Management
• 4.1 Acute Stroke Unit Care
• 4.2 Brain Imaging
• 4.3 Blood Glucose
• 4.4 Acute Thrombolytic Treatment
• 4.5 Carotid Artery Imaging
• 4.6 Dysphagia Assessment
• 4.7 Acute Aspirin Therapy
• 4.8 Management of Subarachnoid and
  Intracerebral Hemorrhage

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Rehabilitation

• 5.0 Stroke Rehabilitation
• 5.1 Initial Stroke Rehabilitation Assessment
• 5.2 Provision of Inpatient Rehabilitation
• 5.3 Components of Inpatient Stroke
  Rehabilitation
• 5.4 Identification and Management of Post Stroke
  Depression
• 5.5 Shoulder Pain Assessment and Treatment
• 5.6 Community Based Rehabilitation

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Community

• 6.0 Follow-Up and Community Reintegration
• 6.1 Follow-up and Evaluation in the Community

This section will be further developed in 2008
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Recommendation Format
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Recommendation 1

• Public Awareness and Responsiveness

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1.1 Public Awareness and Responsiveness

• All persons (members of the public) should be
  able to recognize and identify at least two signs
  and symptoms of stroke and to know to take
  appropriate action (seek immediate medical
  attention).
• Sudden weakness, sudden trouble speaking, sudden
  vision problems, sudden headache, sudden
  dizziness

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1.1 Public Awareness and Recognition

• Warning Signs of Stroke
• Weakness Sudden weakness, numbness or tingling
  in the face, arm or leg
• Trouble speaking Sudden temporary loss of speech
  or trouble understanding speech
• Visual problems Sudden loss of vision,
  particularly in one eye or double vision
• Headache Sudden severe and unusual headache
• Dizziness Sudden loss of balance, especially
  with any of the above signs

Heart and Stroke Foundation of Canada, 2006
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System Implications

• Health promotion efforts that contribute to the
  primary prevention of stroke in all communities
  and are integrated with existing chronic disease
  prevention initiatives.
• Public awareness campaigns focusing on the signs
  and symptoms of stroke, including the sudden
  nature of stroke.
• Enhanced public education on the warning signs
  and appropriate response.
• Implementation of Best Practices for EMS,
  physicians and nurses.
• Heightened emergency response with appropriate
  protocols.

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Performance Measures

• Proportion of the population that can name two or
  more stroke symptoms.
• Proportion of patients who seek medical attention
  within 2.5 hours of stroke symptom onset.
• Median time from stroke symptom onset to
  presentation in ED.
• Proportion of emergency medical service providers
  trained in stroke recognition and use of stroke
  triage algorithms for prioritizing stroke cases
  for transport within regions.
• The incidence of stroke in each
  province/territory by stroke type.

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Recommendation 2

• Patient and Caregiver Education

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2.1 Patient and Caregiver Education

• 2.1 a. Information and education should be
  provided for all patients with stroke and their
  families and caregivers, at all stages of care
  across the continuum.
• It should address the nature of the stroke and
  its manifestations, signs and symptoms,
  impairments and their impact and management, risk
  factors, planning and decision making, resources
  and community support.

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2.1 Patient and Caregiver Education

• 2.1b Information and education should be
  interactive, timely, up to date, provided in a
  variety of languages and formats and specific to
  patient, family and caregiver needs and
  impairments.

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System Implications

• Coordinated efforts among stakeholders, both
  national and provincial, public health agencies,
  government and care providers across the
  continuum to produce patient, family and
  caregiver education materials with consistent
  information and messages.
• Coordinated process for ensuring access to
  educational materials, programs, activities, and
  other media related to educational material
  availability, effective dissemination mechanisms
  and follow-up.

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Performance Measures

• Proportion of stroke patients with documentation
  of education provided for patient, family and/or
  caregivers across the continuum.
• Total time spent on patient/family education
  during a healthcare encounter for stroke.

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Implementation Tips

• Form a working group, consider both local and
  regional
• Complete a gap analysis to compare current
  practices using the Canadian Stroke Strategy Best
  Practices Recommendations 2006 Gap Analysis Tool
• Identify strengths, challenges, opportunities
• Identify 2-3 priorities for action

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Implementation Tips

• Identify local and regional champions
• Identify professional education needs and develop
  a professional education learning plan
• Consider local or regional workshops to focus on
  Public Awareness and/or Patient/Caregiver
  Education
• Access resources such as Heart and Stroke
  Foundation, provincial contacts

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