STROKE CARE PATHWAY
THE DOCTOR'S ROUTE THROUGH THE PATHWAY
In summary, the doctor writes:
These documents will now be considered in detail;the pages are reproduced here and annotated in red to explain the need for the data items. There are links to other pages and sites for more detail and supporting evidence.
The doctor's initial assessment starts in the red section, on page 3.
The aims of the initial assessment are:
It is advisable to follow this learning resource using a copy of the Stroke Pathway folder, so as to familiarise yourself with the document.
Starting on page 3:
PATIENT NAME: (Attach identity sticker)You are responsible for ensuring the record relates to the correct patient. If no stickers are available at the time of admission, in addition to the patient's name you should write 2 of:-
address, hospital number, date of birth.
SOURCE OF HISTORY? If this is not the patient, state the relationship of the historian to the patient & the reason patient is unable to give history (eg confused; unconscious)
FAMILY HISTORY: This is particularly important in younger patients (<50yrs)
Hypertension : Y/N
RISK FACTORS: This is all important information for secondary prevention
Smoker: Y/N if 'yes' , how much per day:
Alcohol: Y/N if 'yes', how many units per week:
PAST MEDICAL HISTORY:
Free text entry; include all major conditions & operations, apart from those mentioned above.
In particular ask about arthritis, which may compromise rehabilitation.
DRUGS: Free text entry, but include route & frequency
HOME ARRANGEMENTS: Please state:
Include here whether living alone; who is carer; whether home care support; services;also occupation, if applicable and whether patient drives
PHYSICAL EXAMINATION Page 5
Communication check: This information will be used by all users of the pathway.
Glasgow coma score: (out of 15) This is an important predictor of outcome.
The information entered in this section will be important for secondary prevention
Pulse: Atrial fibrillation is a risk factor
BP Hypertension is a risk factor
Peripheral Pulses: If there are signs of peripheral vascular disease, TEDS are contraindicated
Heart sounds: Valvar heart disease is a risk factor
Concomitant congestive cardiac failure increases Waterlow score and requires a variance record.
RESPIRATORY SYSTEM: Oxygen saturation:
ABDOMEN: Record urinary continence; it is an important prognostic sign for outcome of stroke.
Power graded out of 5 MRC Scale
Is there neglect Yes/No Sensory inattention Yes/No
Gait & movement may have to be assessed later in conjunction with
physiotherapist, depending on the patient's disability.
Gait & movement may have to be assessed later in conjunction with physiotherapist, depending on the patient's disability.
Summary of neurological
deficit : Summarising
the deficit should allow you to deduce where the lesion is most likely
Summarising the deficit should allow you to deduce where the lesion is most likely to be
CLINICAL IMPRESSION This
entry is free-text, allowing you to 'think aloud'. There are specific
aspects of the diagnosis and management below, to be entered in a more
This entry is free-text, allowing you to 'think aloud'. There are specific aspects of the diagnosis and management below, to be entered in a more structured format.
(to be completed by member of medical team)
on links below for further explanation about coding and the classification
of cerebral infarcts:
Click on links below for further explanation about coding and the classification of cerebral infarcts:
Resuscitation Status Review on (insert date) Today’s Date & Initials
This completes the doctor's initial assessment.
Your next entry in this patient's file will be in the orange section, in the acute 5 day plan, click to continue your route through the pathway.
Copyright ©Nikki Devitt 2002, on behalf of the WAHT Stroke Pathway Group
Date of last review: 25th April 2002
Date of next review:25th October 2002