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Stroke Best Practices in Long Term Care

Stroke Best Practices in Long Term Care. Paula Gilmore Regional Coordinator for Community & LTC September 21, 2010. Regional Stroke Community & Long Term Care Coordinator Role.

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Stroke Best Practices in Long Term Care

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  1. Stroke Best Practices in Long Term Care Paula Gilmore Regional Coordinator for Community & LTC September 21, 2010

  2. Regional Stroke Community & Long Term Care Coordinator Role • Facilitate the provision of appropriate services in the community & LTC homes for stroke survivors and their families within SWO • Ensure that outcomes are optimized through provision of care by individuals with stoke expertise and awareness of best practices for stoke care

  3. Stroke Best Practice Recommendations • Canadian Best Practice Recommendations for Stroke Care 2008 • www.canadianstrokestrategy.ca

  4. Best Practices (Transitions) • Discharge Planning should be initiated as soon as possible after patient admission to hospital (incl. ER or inpt.) (CSS, 2008, 4.2g) • Care management plan should include a pre-discharge needs assessment to ensure a smooth transition from rehabilitation back to the community (CSS, 2008, 5.3 vi)

  5. Resources for LTC (Transitions) Transition Information Plan (TIP) Tool Used for admission to LTC in tandem with MDS-HC Completed by therapists/nurses immediately before discharge Ability to complete care plan immediately Risks and goals for future are known Useful for front-line workers Guide for Persons with Stroke about LTC ● Information that will help stroke survivors and their families make decisions about choosing, moving into, and living in a LTC home ● Knowing questions to ask will help stroke survivors find the LTC home that best meet their needs

  6. Best Practices (Recovery) • Severe strokes benefit from inpatient stroke rehabilitation with a longer stay • Earlier, more intense therapy, frontloaded

  7. The Earlier the Better Brain is “primed” to recover

  8. Best Practices (Recovery cont’d) • After leaving the hospital, stroke survivors must have access to specialized stroke care and rehabilitation services appropriate to their needs (CSS, 2008, 5.4; RCP, 2007, Standard #9 &16; HSF, 2003, BPG #17) • All stroke survivors, regardless of where they live, will have equitable access to the same standard of care at the appropriate intensity and duration (RCP, 2007, Standard #13)

  9. Rehabilitation Initiatives • Advocate for equitable access to stroke care & rehabilitation • ESC LHIN – Rehabilitation has been adopted as a Strategic priority - Representation on ESC LHIN Rehab Advisory Network • SW LHIN – Aging at Home Funding for Community Stroke Rehab. Teams • Promote use of standardized measures • Develop new models of stroke care • Community Stroke Rehabilitation Teams • Chatham-Kent Transitional Stroke Program

  10. What are Specialized Community Stroke Rehabilitation Teams? Our program is designed to help stroke survivors, who are no longer in hospital, reach their rehabilitation goals. • Three teams; 8 team members • Affiliated with the District Stroke Centres • Provide individualized post hospital rehabilitation, secondary prevention, caregiver support and community re-integration

  11. Chatham-Kent Transitional Stroke Program Collaborative partnership between Chatham-Kent Health Alliance and Brain Injury Association of Chatham-Kent (BIACK) Creates a bridge for stroke survivors who are re-integrating back into the community Opportunity to participate in social and recreational activities at New Beginnings Clubhouse

  12. Best Practices (Recovery cont’d) • Care provided by individuals with stroke expertise improves outcomes • Example – Terrace Lodge Coaches – Mentoring Program

  13. Resources for LTC • Tips & Tools for Everyday Living: A Guide for Stroke Caregivers • Educational series that provides practical knowledge skills for health care professionals who provide care to stroke survivors • BP Blogger: Stroke Care • Have partnered with author of BP Blogger to dedicate 2 issues/year to stroke care • Topics have included: What is stroke / TIA, Communication, Blood Pressure

  14. Best Practices (Client & Family Education) • Patient and Family Education - Education that is integrated and coordinated should be provided in a timely manner across the continuum of stroke care for all patients with stroke or at risk for stroke, as well as their families and caregivers. (CSS, 2008, 1.2) • Stroke survivors and their families should be provided with timely, up-to-date information in conjunction with opportunities to learn from members of the interdisciplinary team and other appropriate community service providers. Simple information provision alone is not effective (CSS, 2008, 5.5 viii) • Patients and their caregivers should be offered education programs to assist them in adapting to their new role (CSS, 2008, 5.5 ix) • Family function affects treatment adherence, performance of ADLs and social activity

  15. Resources (Client/Caregiver Education) • Living with Stroke • 8 week education program for stroke survivors and their caregivers • Programs offered throughout SW Ontario • Let’s Talk About Stroke • Information Guide for Stroke Survivors and their Families

  16. Best Practices (Follow-up and Community Reintegration) • People with stroke living in the community should have regular ongoing follow-up assessments to assess recovery, prevent deterioration and maximize functional outcome (CSS, 2008, 5.5; HSF, 2003, BPG #16) • Stroke survivors and their caregivers should have their individual psychosocial and support needs reviewed on a regular basis (CSS, 2008, 5.5 ii) • Identification and management of post-stroke depression, should also be observed as part of follow-up and evaluation of stroke survivors in the community (CSS, 2008, 5.5 iv, Recommendation 6.2) • People living in the community who have difficulty with ADL or declining activity at 6 months or later after stroke should have access to therapy services for appropriate targeted rehab ( CSS, 2008, 5.5 iii, v)

  17. Depression Post Stroke • All patients with stroke should be considered to be at a high level of risk for depression • Prevalence of major depression – 9-37% in the first 6 months, 5-16% in the next year and 19-21% thereafter in studies involving n>1725 (Whyte, Bio Psychiatry, 2002; 52: 253-264) • Post stroke depression is associated with • Increased mortality • Assistance required with daily tasks (i.e. dressing) • Slower progress in therapy and length of stay • Poor cognitive function (i.e. memory, problem solving) • Increased handicap • Failure to return to work

  18. Factors Most Associated with Participation • Psychological components • Depressive affect • Acceptance of the situation • Emotional distress (Desrosiers et al, 2008)

  19. Best Practices (Social Support & Participation) • Assist stroke survivors to maintain, enhance, and develop appropriate social support (HSF, 2003, BPG #19) • Social isolation following a stroke is significantly associated with risk for recurrent stroke or death (Boden-Albala, 2005) • Leisure education programs can help to increase participation and satisfaction and to reduce depressive symptoms after stroke (Desrosiers et al, 2005) • Stimulating environments with increased activity improve outcomes

  20. Key Messges - STROKE S – Support the Stroke Survivor and Family T – Take Preventative Measures R – Reassess Regularly O – Observe for Depression K – Know the Signs and Symptoms of Stroke (Call 911) E – Encourage Independence & Participation

  21. Helpful Stroke Websites • SWO Stroke Strategy Website (SWO Specific Information) • www.swostroke.ca • Heart and Stroke Foundation of Ontario Website (General Information) • www.heartandstroke.ca • Evidence Based Review of Stroke Rehabilitation • www.ebrsr.com • StrokEngine Website (Rehabilitation) • www.medicine.mcgill.ca/Strokengine/ • Prevent Stroke Website (Prevention) • www.preventstroke.ca

  22. Final thoughts

  23. For more information.... Paula Gilmore Regional Stroke Community & LTC CoordinatorLondon Health Sciences Centre 519-337-1000 ext. 6245 Paula.gilmore@lhsc.on.ca Website: www.swostroke.ca

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