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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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slide1

Stroke

Implementing NICE guidance

2008

NICE clinical guideline 68

what this presentation covers
What this presentation covers
  • Introduction
  • Scope
  • Key priorities for implementation
  • Costs and savings
  • Discussion
  • Find out more
introduction
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
scope
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
key priorities for implementation
Key priorities for implementation
  • Rapid recognition of symptoms and diagnosis
  • Specialist care for people with acute stroke
  • Nutrition and hydration
rapid recognition of symptoms and diagnosis
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

rapid recognition of symptoms and diagnosis7
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
specialist care for people with acute stroke 1
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
specialist care for people with acute stroke 2
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
specialist care for people with acute stroke 3
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
nutrition and hydration
Nutrition and hydration
  • Screen swallowing on admission before giving any oral food, fluid or medication
costs and savings
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.
for discussion
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?
find out more
Find out more
  • Visit www.nice.org.uk/CG068 for:
    • Other guideline formats
    • Costing report and template
    • Audit support
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