North Gwent Acute Stroke Service Our Progress So Far ………

Where are we? North of ‘Gwent Healthcare NHS Trust ’

Market Town Of Abergavenny

Where Is Our Stroke Unit? Based in Nevill Hall Hospital

Acute Stroke Unit

The Acute Stroke Unit Approximately 350 Acute Strokes per year 40 + TIA Referrals/ month so far – seen in a 5-day TIA clinic 22 bedded Acute Stroke Unit and General Rehabilitation Ward 4 Ring-fenced beds? Direct Admission Policy No exclusion Policy

The Multidisciplinary Team 2 Stroke Consultants 2 CNS Stroke 3 Physiotherapists 1 Occupational Therapist 1 Speech & Language therapist 1 Dietician 2 Rehabilitation Assistants 1 Ward Manager Registered and Unregistered nursing staff

AWSSIC First meeting November 2007 Local meetings held every 6-8 weeks Well supported by Michelle Price Motivated MD team Working together on a daily basis Longevity of working relationships

Areas of Weakness Identified Via ….. Audit inc Sentinel Audit Poor bundle success Satisfaction questionnaires Carers clinic Informal complaints Group discussion Bed crisis

Weaknesses Included.. 1.No data collection method 2. Patients weight not clearly documented 3. Lack of dietetic stroke protocols 4. No ‘Time’ on Manual Handling Assessments

Weaknesses continued …. 5. Acute areas not familiar with ROSIER 6. No evidence of information given to carers 7. No Barthel on discharge 8. OT + PT initial assessments not recorded consistently in patient notes

Weaknesses continued …. 9. Assessment + Rehab lacking at weekends 10. No clear Admission Policy to ASU 11. No SLT screening for communication issues in first days bundle 12. Lack of awareness of our work with NLIAH amongst colleagues

What We Did…. Some Simple Solutions Invent a Sticker for Everything!

Solutions 1. Redesigned data collection form and agreed where to keep it 2. Adapted Ward Transfer Sticker 3. Dietetics – redesigned sticker for notes 4. Added date and times to Manual Handling Assessments

Solutions cont/d… 5. Carried out ROSIER training in acute areas 6. Introduced a checklist sticker for information packs given to patient/carers 7. Amended Barthel Score Sheet 8. OT & PT introduced Assessment stickers

Solutions cont/d… 9.Two Rehabilitation Assistants and one qualified physiotherapist to cover weekends 10. Managers and clinicians agreed the ‘Ring fenced bed’ and ‘Direct Admission’ policies 11. Speech and Language Therapist accepting blanket stroke patient referrals 12. CNS provided update sessions on Stroke Developments

Obstacles Encountered Lack of clerical support Extra work – data collection Low on medical colleagues agenda Physiological monitoring installation delay Staff on leave Keeping all staff on board SO MUCH ELSE GOING ON!

Benefits So Far …. Improved bundle success – but could do better Enhanced patient care inc 7-day Rehab A chance to evaluate and evidence what we were already doing Strengthening working relationships Promoted stroke service awareness across the local and wider areas

The End We are happy to share and discuss anything that may be if interest to you Thank you