Stroke Implementing NICE guidance 2008 NICE clinical guideline 68.

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Stroke Implementing NICE guidance 2008 NICE clinical guideline 68

Transcript of Stroke Implementing NICE guidance 2008 NICE clinical guideline 68.

Page 1: Stroke Implementing NICE guidance 2008 NICE clinical guideline 68.

StrokeImplementing NICE guidance

2008

NICE clinical guideline 68

Page 2: Stroke Implementing NICE guidance 2008 NICE clinical guideline 68.

What this presentation covers

Introduction

Scope

Key priorities for implementation

Costs and savings

Discussion

Find out more

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Introduction

Stroke is a major health problem in the UK

Each year in England:• 110,000 people have a first or recurrent stroke• a further 25,000 people have a TIA

Over 900,000 people are living with the effects of stroke

Estimated annual cost of stroke is around £7 billion

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Scope

The guideline covers the initial care of people over 16 years with TIA or completed stroke

It gives recommendations for:• primary and secondary healthcare settings, including

referral to tertiary care • pre-hospital emergency care settings, including

ambulance services

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Key priorities for implementation

•Rapid recognition of symptoms and diagnosis

•Specialist care for people with acute stroke

•Nutrition and hydration

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Rapid recognition of symptoms and diagnosis

Reproduced with permission from The Stroke Association

• Use the FAST tool to screen for stroke or TIA outside hospital

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Rapid recognition of symptoms and diagnosis

• Ensure that people who have had a suspected TIA who are at high risk of stroke (ABCD2 score of 4 or above) have:

– aspirin (300 mg) started immediately– specialist assessment and investigation within 24

hours of symptom onset– measures for secondary prevention introduced

• Treat all people with crescendo TIA as being at high risk of stroke

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Specialist care for peoplewith acute stroke (1)

• Admit anyone with a suspected stroke directly to a specialist acute stroke unit following initial assessment, from the community or from A&E

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Specialist care for peoplewith acute stroke (2)

• Perform brain imaging immediately if any of these apply:

- indications for thrombolysis or early anticoagulation treatment

- on anticoagulant treatment

- a known bleeding tendency

- a depressed level of consciousness

- unexplained progressive or fluctuating symptoms

- papilloedema, neck stiffness or fever

- severe headache at onset of stroke symptoms• Otherwise brain imaging should be performed as soon as possible

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Specialist care for peoplewith acute stroke (3)

• Thrombolysis with alteplase:

– administer within a well-organised stroke service

– may be used in A&E with appropriate training and support

– protocols should be in place for delivery and management of thrombolysis

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Nutrition and hydration

• Screen swallowing on admission before giving any oral food, fluid or medication

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Costs and savings

The guideline on stroke is likely to result in a significant change in resource use in the NHS:

• assessment of people who have had a suspected transient ischaemic attack (TIA), and

identifying those at high risk of stroke• magnetic resonance imaging for people who

have had a suspected TIA• referral for carotid endarterectomy• admission to a specialist stroke unit• performing brain imaging immediately where

indicated for people with acute stroke.

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For discussionHow do you assess staff competence in the use of methods for rapid recognition of symptoms of stroke or TIA?

How can you ensure that staff are aware of the benefits of providing emergency care for a patient with a stroke or TIA?

How can you ensure that the imaging recommendations are followed 24 hours a day?

What systems do you have in place to ensure there are enough trained staff to provide a swallowing test on admission?

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Find out more

Visit www.nice.org.uk/CG068 for:

•Other guideline formats•Costing report and template•Audit support