1. Canadian Best Practice Recommendations for Stroke Care Recommendation 1: Public Awareness and Patient Education (Updated 2008)

2. 1.1 Public Awareness and Responsiveness  All members of the public should be able to recognize and identify the signs of stroke which include:  Sudden weakness  Sudden trouble speaking  Sudden vision problems  Sudden headache  Sudden dizziness  Public education on stroke should emphasize that stroke is a medical emergency, and that immediate medical attention should be sought. All members of the public should know to take the appropriate actions –call 9-1-1 or their local emergency number.  Public education should include information that stroke can affect persons of any age - from newborn and children to adults.

3. 1.1 Public Awareness and Responsiveness  Successful care of the acute stroke victim as an emergency depends on a 4 step chain. Activation of EMS Rapid Recognition and Reaction Priority Transport with notification Rapid, accurate diagnosis And treatment

4. System Implications  Health promotion efforts that contribute to the primary prevention of stroke in all communities and are integrated with existing chronic disease prevention initiatives.  Public awareness initiatives focusing on the signs of stroke, including the sudden nature of stroke  Enhanced public education on the warning signs and appropriate response.  Training and education for emergency medical services, physicians and nurses related to recognition, rapid assessment and management.  Heightened emergency response with appropriate protocols.

5. Selected Performance Measures  Proportion of the population that can name two or more stroke symptoms.  Proportion of the population that can name the three dominant stroke symptoms: sudden weakness, trouble speaking, vision problems.  Median time from stroke symptom onset to presentation in ED.

6. 1.2 Patient and Family Education  An integral part of stroke care that should be addressed at all stages across the continuum of stroke care.  Education includes transfer of information and skills and may include additional training to transfer skills for self/patient management.  Education that is integrated and coordinated should be provided in a timely manner across the continuum of care for all patients with stroke or at risk for stroke, as well as their families and caregivers.

7. 1.2 Patient and Family Education  Education content should be specific to the phase of care or recovery across the continuum and appropriate to the patient/family/caregiver readiness and needs.

8. 1.2 Patient and Family Education  The scope of educational content should cover all aspects of care and recovery:  The nature of stroke & its manifestations  Signs  Impairments, their impact and management o Caregiver training o Risk factors o Post-stroke depression o Cognitive impairment o Discharge planning & decision making o Community resources o Services and support programs o Environmental adaptations and benefits

9. 1.2 Patient and Family Education  Education should be:  Interactive  Timely  Up-to-date  Provided in a variety of languages and formats (oral, written, aphasia friendly, group, counseling approach)  Specific to patient, family and caregiver needs and impairments  Ensure communicative accessibility for stroke survivors  Clinicians and teams should develop processes for routine patient, caregiver and family education in which designated team members are responsible for provision and documentation of education.

10. System Implications  Coordinated efforts among stakeholders, both national and provincial, public health agencies, government and care providers across the continuum to produce patient, family and caregiver education materials with consistent information and messages.  Resources such as stroke recovery support groups, available in the community to provide ongoing support and education following hospital discharge.

11. System Implications  Coordinated process for ensuring access and awareness to educational materials, programs, activities, and other media, effective dissemination mechanisms and follow-up.  Access to training for care providers in programs that facilitate communication with stroke survivors with aphasia.

12. System Implications  Educational resources that are culturally and ethnically appropriate, available in languages other than English and French where possible and address the needs of the patients with aphasia.

13. Selected Performance Measures  Proportion of stroke patients with documentation of education provided for patient, family and/or caregivers across the continuum.  Total time spent on patient/family education during a health care encounter for stroke.

14. Implementation Tips  Form a working group- consider both local and regional stakeholders and include a stroke survivor and family.  Complete a gap analysis to compare current practices using the Canadian Best Practice Recommendations: 2008 Gap Analysis Tool.  Identify strengths, challenges, opportunities.  Identify 2-3 priorities for action.

15. Implementation Tips  Identify local and regional champions.  Identify professional education needs and develop a professional education learning plan.  Consider local or regional workshops to focus on Public Awareness and/or Patient/Caregiver Education.  Access resources such as Heart and Stroke Foundation, Provincial Contacts, stroke recovery groups.