TO WESTON AREA HEALTH TRUST'S
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
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:
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
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.
- 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
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.
- The yellow
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
- 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
- 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.
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.
enter their initial assessment in the red
all disciplines enter their weekly goal-planning summary in the
Top of page