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Module 4 Stroke Rehabilitation & Community Reintegration

N. S. N. C. Module 4 Stroke Rehabilitation & Community Reintegration. Best Practice Nursing Care Across the Acute Stroke Continuum. 1. Stroke Rehabilitation & Community Reintegration. Welcome!. This session includes presentations and activities to participate in with your colleagues

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Module 4 Stroke Rehabilitation & Community Reintegration

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  1. N S N C Module 4Stroke Rehabilitation& Community Reintegration Best Practice Nursing Care Across the Acute Stroke Continuum 1

  2. Stroke Rehabilitation & Community Reintegration Welcome! This session includes presentations and activities to participate in with your colleagues The focus is on working with colleagues to discover best ways of using the tools in your clinical settings So, sit back (or stand up) and have fun!!! 4/2/2014 2

  3. Stroke Rehabilitation & Community Reintegration So, what do you want to get out of this module? Expectations? 4/2/2014 3

  4. Stroke Rehabilitation & Community Reintegration Identify the goal of stroke rehabilitation and community reintegration within the stroke care continuum Identify the benefits of early assessment and stroke rehabilitation Review Best Practice Recommendations related to stroke rehabilitation and community reintegration Identify opportunities to begin implementing these at your institution Identify your role in patient and caregiver education Create a stroke care action plan for stroke rehabilitation and community reintegration Objectives 4/2/2014 4

  5. Stroke Rehabilitation & Community Reintegration Agenda Introduction 15 min Stroke 101(optional) 15 min Early Assessment & Stroke Rehabilitation 15 min Initial Stroke Rehabilitation Assessment BPRs 30 min Break 15 min Provision of Inpatient Stroke Rehabilitation BPRs 30 min Patient and Family Education 15 min Community Reintegration 45 min Putting It All Together 30 min 4/2/2014 5

  6. Stroke Rehabilitation & Community Reintegration Continuum of Stroke Care Prevention of strokePublic awareness & patient education Hyperacute stroke management Acute inpatient stroke care Stroke rehabilitation & community reintegration

  7. Stroke Rehabilitation & Community Reintegration Continuum of Stroke Care Prevention of strokePublic awareness & patient education Rehabilitation and discharge planning begin at the time of admission to acute care Hyperacute stroke management Acute inpatient stroke care Stroke rehabilitation & community reintegration

  8. Stroke Rehabilitation & Community Reintegration Why Is This Important? Early consultation with rehab professionals can reduce complications from immobility such as falls and DVT Facilitates early discharge planning for transition to rehab units or the community Early assessment should reduce overall cost of episode of care through improved outcomes and reduced time to discharge.

  9. Stroke Rehabilitation & Community Reintegration Canadian Best Practice Recommendations for Stroke Care Synthesis of best practice recommendationsfor stroke care across the continuum Address critical topic areas Commitment to keep current and update every two years First edition released in 2006 Current update released in 2008 With four new recommendations Elaboration of existing ones www.cmaj.ca December 2, 2008

  10. Stroke 101 Acute Inpatient Stroke Care Intended only for audiences with no previous knowledge of stroke. 4/2/2014 10

  11. Stroke Rehabilitation & Community Reintegration Early Assessment & Stroke Rehabilitation 15 min 4/2/2014 11

  12. Stroke Rehabilitation & Community Reintegration 4/2/2014 12 When should stroke rehabilitation start?

  13. Stroke Rehabilitation & Community Reintegration OVERVIEW Acute stroke accounts for the longest length of stay in Canadian hospitals and places a significant burden on inpatient resources, which increases further when complications are experienced. Consider that rehabilitation is a process, not a place. Rehabilitation and discharge planning beginat the time of admission to acute care

  14. Stroke Rehabilitation & Community Reintegration 4/2/2014 14 What are the benefits of early assessment and rehabilitation?

  15. Stroke Rehabilitation & Community Reintegration Assessment should start as early as possible in the ER and continue through the inpatient and community reintegration phases Benefits of Early Assessment & Rehabilitation 4/2/2014 15

  16. Stroke Rehabilitation & Community Reintegration Early consultation with rehab professionals: Contributes to reductions in complications from immobility such as joint contracture, falls, aspiration pneumonia and deep vein thrombosis Contributes to early discharge planning for transition from acute care to specialized rehabilitation units or to the community Should reduce the overall cost of care through improved outcomes and reduced time to discharge (BPG 5.1) Benefits of Early Assessment & Rehabilitation 4/2/2014 16

  17. Stroke Rehabilitation & Community Reintegration Clinicians should use standardized, valid assessment tools to evaluate stroke-related impairments and functional status Examples of Assessment Tools 4/2/2014 17

  18. Stroke Rehabilitation & Community Reintegration Your Role in Early Assessment and Stroke Rehabilitation At your tables discuss What are the benefits of early assessment and stroke rehabilitation at your institution? Where can you make a difference in realizing these benefits? What barriers and enablers do you see? When done, we'll review some of your pearls of wisdom! TABLE ACTIVITY

  19. Stroke Rehabilitation & Community Reintegration Initial Stroke Rehabilitation Assessment Best Practice Recommendations 20 min 4/2/2014 19

  20. Stroke Rehabilitation & Community Reintegration All persons with stroke should be assessed for their rehabilitation needs: Inpatients should have initial assessment as soon as possible, preferable within 24 to 48 hours Patients not admitted to hospital should undergo a comprehensive outpatient assessment for functional impairment Clinicians should use standardized, valid assessment tools to evaluate the patient's stroke-related impairments and functional status Survivors of a severe or moderate stroke should be reassessed at regular intervals for their rehabilitation needs 5.1 Initial Stroke Rehabilitation Assessment OVERVIEW

  21. Let’s take a break… 15 min

  22. Stroke Rehabilitation & Community Reintegration Provision of Inpatient Stroke RehabilitationBest Practice Recommendations 30 min

  23. Stroke Rehabilitation & Community Reintegration Treatment in a comprehensive or rehabilitation stroke unit by an interdisciplinary team: Rehabilitation care formally coordinated and organized Specialist rehabilitation team on a geographically defined unit Delivered by a variety of treatment disciplines, experienced in providing post-stroke care 5.2 Provision of inpatient stroke rehabilitation OVERVIEW

  24. Stroke Rehabilitation & Community Reintegration Treatment in a comprehensive or rehabilitation stroke unit by an interdisciplinary team: The interdisciplinary rehabilitation team should assess patients within 24 to 48 hours of admission and develop a comprehensive individualized rehabilitation plan Opportunity to participate in inpatient stroke rehabilitation Stroke unit teams should conduct at least one formal interdisciplinary meeting per week Use standardized, valid assessment tools to evaluate the patient's stroke-related impairments and functional status 5.2 Provision of inpatient stroke rehabilitation OVERVIEW

  25. Stroke Rehabilitation & Community Reintegration 5.3 Components of inpatient stroke rehabilitation All patients with stroke should begin rehabilitation therapy as early as possible once medical stability is reached: Should receive the intensity and duration of clinically relevant therapy defined in their individualized rehabilitation plan Should receive minimum of 1 hour of direct therapy Should promote practice of skills gained in therapy into daily routine

  26. Stroke Rehabilitation & Community Reintegration 5.3 Components of inpatient stroke rehabilitation All patients with stroke should begin rehabilitation therapy as early as possible once medical stability is reached: Should include repetitive and intense use of novel tasks Should conduct at least one formal interdisciplinary meeting per week at which patient problems are identified, rehabilitation goals set, progress monitored and support after discharge planned Care management plan should include a predischarge needs assessment to ensure smooth transition back to the community

  27. Stroke Rehabilitation & Community Reintegration Rehab Assessment Briefing-1 At your tables, review one of the following recommendations: 5.1 Initial stroke rehabilitation assessment 5.2 Provision of inpatient stroke rehabilitation 5.3 Components of inpatient stroke rehabilitation Have each person select one of the following topics to prepare a briefing on: Recommendation Rationale System implications Performance measures Use the worksheet in your PW to structure your briefing When done, present your briefing to your table and discuss Imagine you have been asked to brief your colleagues back home on Initial stroke rehabilitation assessment. TABLE ACTIVITY

  28. Stroke Rehabilitation & Community Reintegration Rehab Assessment Briefing-2 Now, we’ll debrief the large group on the following key questions about this recommendation: How will this recommendation improve stroke care at your institution? What role can you play in implementing it? What barriers or enablers do you see? Imagine you have been asked to brief your colleagues back home on Initial stroke rehabilitation assessment. TABLE ACTIVITY

  29. Patient and Family Education Stroke Rehabilitation & Community Reintegration 15 min

  30. From the Patient and Family’s Perspective:

  31. Stroke Rehabilitation & Community Reintegration Where You Can Make a Difference! At your tables, discuss: What would be your role in educating and supporting patients and caregivers about rehabilitation and community reintegration? When done, we'll debrief the whole group to identify some best practices Did you know that skills training of caregivers makes a huge difference in patient outcomes in areas of functionality and depression!

  32. Stroke Rehabilitation & Community Reintegration Patient and Family Education Content should be specific to; The phase of care Patient/caregiver readiness Patient/caregiver needs Education should be timely, interactive, up to date and provided in a variety of formats, languages including aphasia friendly Processes should be established by clinical teams for education including designating team members for provision and documentation of education REVIEW

  33. Stroke Rehabilitation & Community Reintegration Patient and Family Education Education content should include: The nature of the stroke and its manifestations Signs and symptoms of stroke Impairments and their impact on the person Caregiver training to manage Risk factors Post-stroke depression Cognitive impairment Discharge planning and decision making Community resources Home adaptations REVIEW

  34. Stroke Rehabilitation & Community Reintegration www.heartandstroke.ca  Patient and Family Education

  35. Community Reintegration Stroke Rehabilitation & Community Reintegration 45 min

  36. Stroke Rehabilitation & Community Reintegration OVERVIEW 4/2/2014 36 What are some elements of community reintegration?

  37. Stroke Rehabilitation & Community Reintegration 5.4 Outpatient & community-based rehabilitation After leaving hospital, stroke survivors must have access to specialized stroke care and rehabilitation services appropriate to their needs: Early supported discharge services and transition planning Occupational therapy or multidisciplinary interventions Multifactorial interventions re: risk of falling, Exercise program and monitored throughout Supportive conversation techniques Swallowing therapy and opportunity for reassessment OVERVIEW

  38. Stroke Rehabilitation & Community Reintegration 5.5 Follow-up & community reintegration People with stroke should have regular and ongoing follow-up assessment to assess recovery, prevent deterioration and maximize functional outcome: Follow up by primary care provider Individual psychosocial and support needs reviewed Access to therapy to improve or prevent deterioration OVERVIEW

  39. Stroke Rehabilitation & Community Reintegration 5.5 Follow-up & community reintegration People with stroke should have regular and ongoing follow-up assessment to assess recovery, prevent deterioration and maximize functional outcome: Identification and management of post-stroke depression Assessment for appropriate targeted rehabilitation Provision with timely, up-to-date information Offered education programs to assist in adapting OVERVIEW

  40. Stroke Rehabilitation & Community Reintegration Selling the Recommendations At your tables, review the recommendations for community reintegration, then put together a briefing for selling them to your institution: How will they improve stroke care at your institution? What role can you play in implementing them? What barriers or enablers do you see? What are the system implications? What performance measures would you use? Use the worksheet in your PW to structure your briefing When done, we’ll debrief to identify some key points Imagine you have been asked to “sell” the recommendations for community reintegration to your institution! TABLE ACTIVITY

  41. Stroke Rehabilitation & Community Reintegration Check Up Quiz QUIZ

  42. Stroke Rehabilitation & Community Reintegration Check Up It should begin at the time of admission to acute care When shouldrehabilitation and discharge planning start? 4/2/2014 42

  43. Stroke Rehabilitation & Community Reintegration Check Up It can reduce costs through improved outcomes and reduced time to discharge. Name two ways in which early assessment can reduce overall cost of care for stroke patients. 4/2/2014 43

  44. Stroke Rehabilitation & Community Reintegration Check Up Inpatients should have initial assessment as soon as possible, preferably within 24 to 48 hours Within what time period should inpatients be assessed for their rehabilitation needs? 4/2/2014 44

  45. Stroke Rehabilitation & Community Reintegration Check Up Patients not admitted to hospital should undergo a comprehensive outpatient assessment for functional impairment What type of assessment should patients not admitted to hospital undergo with respect to their rehabilitation needs? 4/2/2014 45

  46. Stroke Rehabilitation & Community Reintegration Check Up Standardized, valid assessment tools What type of tools should be used to evaluate patient's stroke-related impairments and functional status? 4/2/2014 46

  47. Stroke Rehabilitation & Community Reintegration Check Up Patient problems are identified, rehabilitation goals set, progress monitored and support after discharge planned What patient issues should be addressed at the weekly formal interdisciplinary meeting? 4/2/2014 47

  48. Stroke Rehabilitation & Community Reintegration Check Up Should receive a minimum of 1 hour of direct therapy How much direct therapy should inpatients receive? 4/2/2014 48

  49. Stroke Rehabilitation & Community Reintegration Check Up As early as possible once medical stability is reached When should inpatients with stroke begin rehabilitation therapy? 4/2/2014 49

  50. Stroke Rehabilitation & Community Reintegration Check Up • The phase of care • Patient/caregiver readiness • Patient/caregiver needs Patient and family education should be specific to what key topics? 4/2/2014 50

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