Presentation is loading. Please wait.

Presentation is loading. Please wait.

Australian Stroke Coalition Assessment for Rehabilitation: Pathway and Decision- Making Tool Susan Hillier on behalf of the ASC Rehabilitation Working.

Similar presentations


Presentation on theme: "Australian Stroke Coalition Assessment for Rehabilitation: Pathway and Decision- Making Tool Susan Hillier on behalf of the ASC Rehabilitation Working."— Presentation transcript:

1 Australian Stroke Coalition Assessment for Rehabilitation: Pathway and Decision- Making Tool Susan Hillier on behalf of the ASC Rehabilitation Working Group and SA Stroke Network

2 Australian Stroke Coalition Learning objectives This presentation will enable you to: –Recognise the importance of standardised rehabilitation assessment for people with stroke –Introduce the recommended rehabilitation pathway after stroke –Explain who should receive rehabilitation and the four exceptions

3 Australian Stroke Coalition Learning objectives (cont) –Explain how to use the Rehab Assessment and Decision-Making Tool –Determine the appropriate rehabilitation setting using the Rehab Assessment and Decision-Making Tool –Determine the degree and nature of rehabilitation (domains) using the Rehab Assessment and Decision-Making Tool

4 Australian Stroke Coalition Background Currently only 41% of people with stroke are assessed for rehabilitation (NSF 2011) Processes for Ax are highly variable and inconsistent between individual assessors (Kennedy, in press) Ax is often based on non-clinical factors (Hakkennes 2011) or based on clinical factors that do not have a relationship with rehabilitation outcomes

5 Australian Stroke Coalition Background (cont) Ax is often not based on a person’s capacity to improve (Ilet 2010) Assessment processes are poorly documented All leading to the potential for ad hoc and potentially unfair decision making

6 Australian Stroke Coalition Assessment for Rehabilitation: Pathway and Decision- Making Tool

7 Australian Stroke Coalition Aims All stroke survivors in Australia should be assessed for rehabilitation This assessment should be: –Accountable, timely and transparent –Fair and consistent –Based on needs, not service availability, in the first instance –Include person, multidisciplinary team, family –Based on best available evidence

8 Australian Stroke Coalition Who should receive rehabilitation? Stroke survivors may be rejected or never considered for rehabilitation due to: –Age –Rehab services not able to cater for severity or co-morbidities –Lived alone prior to stroke –Potential for long stay –Poor relationships between service providers –Deemed ‘not likely to benefit’

9 Australian Stroke Coalition Who should receive rehabilitation? HOWEVER A systematic literature search failed to identify any clear indicators (clinical or otherwise) that could be used to determine ineligibility or unlikely to benefit from Rehab. It is therefore recommended that ALL STROKE SURVIVORS RECEIVE REHAB unless they meet one of the four exceptions.:

10 Australian Stroke Coalition Exceptions to rehabilitation 1. Return to pre-morbid function: Stroke survivor has made a full recovery in all aspects including physical, emotional, psychological and cognitive. 2. Palliation: Death is imminent; refer to the palliative care team.

11 Australian Stroke Coalition Exceptions to rehab (cont.) 3. Coma and/or unresponsive, not simply drowsy: Determined by criteria for minimally responsive, i.e. responds to stimuli meaningfully as able. 4. Declined rehabilitation: Stroke survivor does not wish to participate in rehabilitation. If a stroke survivor meets any of these exceptions, regular monitoring is required to evaluate whether the exception is ongoing

12

13 Australian Stroke Coalition Pathway (cont) Flags include: Premorbid conditions +/- ↓premorbid function Severe cognitive impairment High level medical/surgical acuity Non-compliance, apathy ↓social support/ accommodation options Double incontinence Somatoform disorders Co-morbidities (particularly those associated with ageing)

14 Australian Stroke Coalition When, where and who uses the Rehab Decision-Making Tool Evidence suggests that rehabilitation should begin as early as possible (Bernhardt 2008) so assessment for rehabilitation should also be early. Pilot testing suggests commencing the process 48 hours after admission to help guide patient management. The Decision-Making Tool should be used in stroke units, but it can be used in other settings

15 Australian Stroke Coalition When, where and who uses the Rehab Decision-Making Tool MDT members complete the sections relevant to their practice and/or The tool can be completed at a meeting with the MDT and the family or at ward rounds, formal or informal review meetings or within other local processes With familiarity takes about 10 minutes Can be updated as required during the hospital stay

16

17

18 Australian Stroke Coalition Environment and participation documentation In order to provide a more complete picture of the stroke survivor and their rehabilitation needs there are two further tables (consistent with the WHO ICF model): Participation – this documents previous roles and need for rehabilitation Environment – documenting pre-stroke environment and flagging need for intervention if barriers identified

19 Australian Stroke Coalition Example of participation section Participation (consistent with ICF Framework)Roles/s pre-stroke Need for rehabilitation/intervention? Y/N and if yes, plan? DomesticHelped with cooking/cleaning Serviced cars and did majority of gardening Y – incorporate raised bed gardening tasks in rehab VocationalAccountantY – incorporate book- keeping tasks in SP sessions RecreationalClassic car club memberY – attend meetings, friends rostered to assist with transport and access SocialLocal pub for Friday drinksN – able to resume attendance (light beer)

20 Australian Stroke Coalition Example of environment section EnvironmentPre-stroke (note barriers and facilitators) Need for intervention? Y/N and if yes, plan? HomeTwo storey house, bedroom upstairs, downstairs shower and toilet with guest bedroom accessible/ Wide home for 6/12 LSL; family available on roster for respite One stair to backdoor, front door no steps. Shed accessible. Y – needs rail in downstairs toilet and bathroom; pole for bed; ramp + rail for backdoor. ExtendedCar club rooms two steps; car park 5m from room. Local pub – accessible Accountancy firm - accessible N – but monitor and instigate plan as necessary

21 Australian Stroke Coalition Summary 1.Pathway - Consider exceptions to rehabilitation. If they do not apply proceed with decision making tool 2.Decision making tool: –Domains – level of in/dependence plus –Need for rehabilitation and level –Where –Participation and environmental considerations

22 Australian Stroke Coalition Implementation We recommend a clear implementation process: 1.Raise awareness of pathway and tool generally in your institution 2.(Conduct audit of current practice) 3.Hold formal education session/s to become familiar with details and processes 4.Discuss implementation as a team - Facilitators such as site champion -Barriers such as misunderstandings, time, resistance to documentation

23 Australian Stroke Coalition Additional slides: 1.Working group members – ASC and SA Stroke Network 2.Methods for initial project 3.Pilot results 4.Modifications

24 Australian Stroke Coalition ASC Rehabilitation working group: Overall mission: People with stroke should receive the right rehabilitation, at the right time, in the right place……….. Dr Geoff Boddice Dr Greg Bowring Ms Cindy Dilworth Dr David Dunbabin Dr Steven Faux Dr Howard Flavell Ms Megan Garnett Dr Erin Godecke Dr Kong Goh Dr Andrew Granger Dr Susan Hillier (chair) Dr Genevieve Kennedy Ms Sandra Lever Dr Natasha Lannin Mr Bill McNamara Ms Jill McNamara Ms Juvy McPhee Mr Chris Price Ms Frances Simmonds Ms Leah Wright

25 Australian Stroke Coalition SA Network Rehabilitation working group: Susan Hillier (Chair), Jodie Aberle, Peter Anastassiadis, Kelli Baker, Elizabeth Barnard, Matt Barrett, Gillian Bartley, Peter Bastian, Maryann Blumbergs, Maree Braithwaite, Jordie Caulfield, Amanda Clayton, Denise Collopy, Maria Crotty, Michelle Curtis, Robyn Dangerfield, Grant Edwards, John Forward, Caroline Fryer, Kendall Goldsmith, Carole Hampton, Peter Hallett, Robyn Handreck, Tony Hewitt, Patricia Holtze, Theresa Hudson, Venugopal Kochiyil, Catherine Lieu, Shelley Lush, Elizabeth Lynch, Annette McGrath, Antonia McGrath, James McLoughlin, Jo Murray, Lee O’Brien, Debra Ormerod, Elizabeth Sloggett, Sally Sobels, Yvonne Tiller, Roly Vinci, Anne Walter, Lauri Wild, Brad Williams, Cathy Young.

26 Australian Stroke Coalition Aim: to devise a process for assessing people for stroke rehabilitation, that is clear, consistent and based on need in the first instance. Method: National survey of current practice Expert working groups Systematic search of the literature* * Funding from Bayer Australia 52 sites 40 great minds 104 articles

27 Australian Stroke Coalition Piloting – in sites in most states (n=6) Positives: ensured clear and accountable decision- making, focused on the person with stroke and their family (not services) Increased involvement of all stroke team members More wholistic as based on the ICF- WHO framework.

28 Australian Stroke Coalition Piloting – in sites in most states (n=6) Negatives: Already do it Haven’t got time No outcome measures Unrealistic because some people don’t improve with rehabilitation

29 Australian Stroke Coalition Changes and additions Wording Recommend commences in first 48 hrs – at minimum within first week Done at team meetings with family if at all possible and updated similarly Can be championed by one person but needs whole team input Use as handover between services

30 Australian Stroke Coalition Changes and additions Initially time consuming but with practice can be 10 mins Format that can be adapted to suit local record keeping Maintain integrity of intention Useful for stroke survivor/family ? as held record Stress this is survivor-centred and services may not exist to match identified need (YET)

31 Australian Stroke Coalition For further information about the Rehabilitation Assessment and Decision-making tool please contact either: Susan Hillier – or Leah Wright –


Download ppt "Australian Stroke Coalition Assessment for Rehabilitation: Pathway and Decision- Making Tool Susan Hillier on behalf of the ASC Rehabilitation Working."

Similar presentations


Ads by Google