STROKE CARE PATHWAY

 
   

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INTRODUCTION TO WESTON AREA HEALTH TRUST'S

INTEGRATED CARE PATHWAY FOR STROKE

It will greatly help your understanding of the pathway if you have a copy of the Stroke Care Pathway folder, which you can follow as you go through this section.

THE PURPOSE of THE PATHWAY

The pathway is designed to follow the patient's journey throughout the hospital stay, from admission to discharge.

All patients with suspected stroke should be commenced on the pathway, even if the diagnosis is not confirmed. If the diagnosis turns out to be something else, the pathway is simply discontinued at that point.

THE STRUCTURE of THE PATHWAY

This is a brief run-through the sections of the pathway, for orientation purposes. Detailed explanation of the documentation can be found either by clicking on the respective health professional's route through the pathway, or by clicking on the appropriate section of the pathway (see contents, left).

If you open the red folder you will see that the pathway is divided into five colour-coded sections. In order these are:

  1. The red section: Multidisciplinary Initial Assessment

    This contains the proformas for the initial assessment by each discipline. It includes a page for assessment on arrival in A&E, and detailed clerking proformas for the doctor, nurse, physio, occupational therapist and speech therapist, with prompts to remind clinicians of best practice. These are based on the National Guidelines for Stroke, published by the Royal College of Physicians.

    The nursing assessment includes the pre-stroke Bartel score, which is a measure of independence in everyday activities. This score is entered on the Gloucester Patient Profile, which you will also find in this section.The Stroke Association booklet 'After your Stroke',is also filed here, and should be given to the patient or carer.

  2. The orange section:The Acute 5-day Plan & Follow-up notes

    The first page in this section is a matrix which includes reminders to all disciplines about management tasks in the first 5 days. Nothing should be recorded on this page; it is for information only.

    The next 5 sheets are structured forms, which will provide the medical record for the patient over these 5 days. All disciplines, including doctors, nurses and therapists should record their findings and their actions here.

    The records after the first 5 days are kept on normal continuation sheets and have no special structure. However they remain multidisciplinary (apart from the nurses who record their care separately in the green section, simply due to the large volume of nursing documentation which accumulates for a typical stroke patient). Each clinician should indicate his or her profession in the margin of the entry on continuation sheets.

  3. The yellow section:Multidisciplinary Goals and Discharge Plans This section includes a proforma for home life assessment, which is completed by the nurse and the occupational therapist. There is also a detailed, structured form to assemble the information required to arrange for the patient's discharge.

    Thirdly, there is a series of multidisciplinary goal planning sheets. These are typically completed by the patient's key-worker following the weekly multidisciplinary meeting, when goals are set for that week's treatment.

  4. The green section: Post 5-day Nursing Record This section contains evidence -based nursing guidelines on all aspects of sroke patients' nursing care. These 4 pages are not to be written on. The record of nursing care is written on the forms which are provided, four days to a 2-page spread.

    If a variance record is required, this fact should be recorded in the bottom right hand cell of the matrix, then the variance records kept in date order at the end of this green section.

  5. The blue section: Completed charts & profiles This section is simply an archive of the charts which have accumulated during the patient's stay, for reference. No health professional makes any new entry in this section.

IN SUMMARY:

Most of the documentation during a patient's admission is done in the green section, if you are a nurse; and in the orange section if you belong to any other discipline.

All disciplines enter their initial assessment in the red section, and all disciplines enter their weekly goal-planning summary in the yellow section.

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Copyright ©Nikki Devitt 2002, on behalf of the WAHT Stroke Pathway Group

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Date of last review: 25th April 2002

Date of next review:25th October 2002