Adherence to Canadian Best Practice Recommendations for Stroke Care: Assessment and Management of Poststroke Depression in an Ontario Rehabilitation Facility

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

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Canadian best practice recommendations for stroke care (updated 2008)

Canadian Medical Association Journal ◽

10.1503/cmaj.081148.r2 ◽

2008 ◽

Vol 179 (12) ◽

pp. S1-S25 ◽

Cited By ~ 100

Author(s):

P. Lindsay ◽

M. Bayley ◽

C. Hellings ◽

M. Hill ◽

E. Woodbury ◽

...

Keyword(s):

Best Practice ◽

Stroke Care ◽

Practice Recommendations

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Abstract 3500: Implementing Best Practice Recommendations to Address Urinary Incontinence after Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3500 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Sarah Donaldson ◽

Erik Leci ◽

Matthew Meyer ◽

Shannon Janzen ◽

Norine Foley ◽

...

Keyword(s):

Urinary Incontinence ◽

Clinical Practice ◽

Best Practice ◽

Stroke Care ◽

Intermittent Catheterization ◽

Bladder Training ◽

Rehabilitation Unit ◽

Practice Recommendations ◽

Number Of Patients ◽

Training Protocol

Background and Purpose: Urinary incontinence following stroke is known to have a detrimental effect on rehabilitation progress, resulting in a slower rate of recovery and less functional independence at discharge. Canadian Best Practice Recommendations for Stroke Care (2010) and the American Stroke Association Clinical Practice Guidelines (2005) recommend that a bladder training program, including timed and prompted toileting on a consistent schedule, be implemented in patients who are incontinent of urine following a stroke. Canadian Best Practice Recommendations for Stroke Care (2010) further recommend intermittent catheterization as an intervention to address urinary incontinence. The aim of the present study was to assess the extent to which the Canadian guidelines are being incorporated into clinical practice. Methods: A retrospective chart review was conducted for consecutive stroke admissions to a neuro-rehabilitation unit in Ontario, Canada over a period of six months. Charts were reviewed for the occurrence of urinary incontinence, whether intermittent catheterization was performed, any mention of bladder training and the documentation of a bladder training protocol. Results: One hundred and four charts were reviewed, after excluding four patients that could not be assessed for urinary incontinence due to other medical conditions. Thirty-three patients were reported to be incontinent of urine during their stay in the rehabilitation unit. Intermittent catheterization was performed for 11 patients (33.3%) with urinary incontinence. Bladder training was indicated as a therapy that was used in the rehabilitation of 16 patients (48.5%). However, a formal bladder training protocol followed by the nursing staff was only documented in 5 patients (15.2%). Conclusions: The rehabilitation of urinary incontinence following stroke is an important issue, with a substantial number of patients failing to receive the recommended therapy. There is a need to develop strategies to promote the application of best-practice recommendations to address urinary incontinence.

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Balancing evidence and opinion in stroke care: the 2008 best practice recommendations

Canadian Medical Association Journal ◽

10.1503/cmaj.081536 ◽

2008 ◽

Vol 179 (12) ◽

pp. 1247-1249 ◽

Cited By ~ 14

Author(s):

M. Bayley ◽

P. Lindsay ◽

C. Hellings ◽

E. Woodbury ◽

S. Phillips ◽

...

Keyword(s):

Best Practice ◽

Stroke Care ◽

Practice Recommendations

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Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care Guidelines, Update 2015

International Journal of Stroke ◽

10.1177/1747493015622461 ◽

2016 ◽

Vol 11 (2) ◽

pp. 239-252 ◽

Cited By ~ 34

Author(s):

Leanne K Casaubon ◽

Jean-Martin Boulanger ◽

Ev Glasser ◽

Dylan Blacquiere ◽

Scott Boucher ◽

...

Keyword(s):

Best Practice ◽

Stroke Care ◽

Practice Recommendations ◽

Care Guidelines

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Canadian Stroke Best Practice Recommendations: Hyperacute Stroke Care Guidelines, Update 2015

International Journal of Stroke ◽

10.1111/ijs.12551 ◽

2015 ◽

Vol 10 (6) ◽

pp. 924-940 ◽

Cited By ~ 120

Author(s):

Leanne K. Casaubon ◽

Jean-Martin Boulanger ◽

Dylan Blacquiere ◽

Scott Boucher ◽

Kyla Brown ◽

...

Keyword(s):

Best Practice ◽

Stroke Care ◽

Hyperacute Stroke ◽

Practice Recommendations ◽

Care Guidelines

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E.02 Streamlining hyperacute stroke management at Royal University Hospital

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.86 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S16-S16

Author(s):

AJ Szmigielski ◽

R Whelan ◽

B Graham ◽

G Hunter ◽

L Peeling ◽

...

Keyword(s):

Best Practice ◽

Retrospective Chart Review ◽

Stroke Care ◽

University Hospital ◽

Vessel Occlusion ◽

Escape Trial ◽

Practice Recommendations ◽

Best Practice Guidelines ◽

Number Of Patients ◽

Software Changes

Background: The Saskatoon stroke program participated in the ESCAPE trial looking at rapid endovascular revascularization for large vessel occlusion. Improvements were necessary to meet the timelines mandates in ESCAPE and to comply with Canadian Best Practice Guidelines. Methods: Retrospective chart review and prospective gathering of key metrics was performed using REDCap (Research Electronic Data Capture) software. Changes adapted from Canadian Best Practice Recommendations for Stroke Care, the ESCAPE protocol, and the Calgary stroke program HASTE project were implemented. Results: Changes implemented included increasing ambulance bypass window to 12 hours, FAST stroke assessment, emergency department pre-notification and registration, stroke alert protocol, team swarm of the patient, administration of tPA in the computed tomography (CT) room, and rapid access to the endovascular suite. Total number of patients between the years 2012 and 2014 was 287, and of those, 93 received tPA. Door-to-CT times decreased from 40 minutes to 21 minutes from 2012 to 2014; and Door-to-Needle (tPA) decreased from 62 minutes to 46 minutes from 2012 to 2014. Conclusions: By following Canadian best practice recommendations for stroke care, the ESCAPE protocol, and adaptation of Calgary stroke program HASTE project, our stroke program implemented changes to reduce treatment times for patients experiencing stroke in our province.

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People With Lived Experience at the Centre of Canadian Stroke Best Practice Recommendations: A Model for Guideline Developers

Journal of Patient Experience ◽

10.1177/2374373520956538 ◽

2020 ◽

Vol 7 (6) ◽

pp. 951-956

Author(s):

M Patrice Lindsay ◽

Natalie Gierman ◽

Jocelyn E Harris ◽

Gavin Arthur ◽

Moira E Teed ◽

...

Keyword(s):

Lived Experience ◽

Best Practice ◽

Guideline Development ◽

Pilot Project ◽

Stroke Care ◽

Evaluation Tool ◽

Review Panel ◽

Practice Recommendations ◽

Development Processes ◽

Clinical Practice Guideline Development

Actively engaging people with lived experience (PWLE) in stroke-related clinical practice guideline development has not been effectively implemented. This pilot project evaluated the feasibility, perceived value, and effectiveness of the Community Consultation and Review Panel (CCRP), a new model to engage PWLE in the writing and review of Canadian Stroke Best Practice Recommendations. Responses to a standardized evaluation tool indicated that participants perceived the CCRP as valued, impactful, effective, and beneficial to stroke care. This project successfully demonstrated that values, experiences, and recommendations of PWLE can be effectively incorporated into guideline content and is applicable to all guideline development processes.

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