P.093 Implementation of virtual interdisciplinary bedside rounds on an acute stroke unit

Background: The novel corona virus pandemic presented the Saskatoon Stroke Program with challenges related to patient- and caregiver-centered communication. Keeping all parties informed of a patient’s health status and plan of care in the setting of extreme visitation restrictions was difficult. Virtual interdisciplinary bedside rounds (VIDR) were introduced to enhance communication for stroke patients. Methods: A video conferencing application was adopted by the Saskatchewan Health Authority. Consent to participate was obtained by a social worker. Bedside nurses facilitated patient participation in VIDR on either a tablet or workstation on wheels, while caregivers were able to attend virtually. Each team member accessed the VIDR from an individual device to maintain social distancing. A structured questionnaire has been initiated to capture participant reported experiences and satisfaction with VIDR (data collection ongoing). Results: Most patients and caregivers were amiable to participate in VIDR. Challenges included: accessing appropriate technology for both family and staff members; rural and remote internet reliability; and maintaining a reasonable duration of rounds. There was overwhelming anecdotal positive feedback from participants. Conclusions: We implemented VIDR to enhance communication during the pandemic. Caregivers felt connected to the care team and up-to-date in the plan of care.

P.092 Successful implementation of a supported conversation program on an acute stroke unit

Background: Aphasia is a life alerting deficit that affects up to 40% of people living with stroke. Barriers to communication ultimately impacts the care aphasic patients receive, as well as functional recovery. The Canadian Stroke Best Practice Recommendations suggest early and frequent language interventions to improve patients with aphasia quality of life, mood, and social outcomes. Methods: A supported conversation (SC) program (colloquially named The Aphasia Club) was implemented on the Acute Stroke Unit (ASU). The program included aphasia awareness and assessment training, as well as creation of an aphasia tool kit and discipline specific aphasia-friendly resources. Staff were encouraged to complete a 1-hour independent course on SC through the Aphasia Institute. Speech and language pathologists (SLP) offered an additional 30-minute in-person teaching session with interdisciplinary practice professionals. Following SLP assessment, personalized communication profiles were created for patients with aphasia to help staff understand the most useful strategies for communication. Results: More then 50 interprofessional staff members took SC training. Staff reported increased levels of knowledge and confidence when communicating with aphasic patients. Conclusions: A supported communication program was successfully implemented on an ASU. Planning appropriate communication interventions can assist interdisciplinary professionals in their ability to support patients through their stroke journey.

MSC 2021 Virtual E-Abstract

1. Challenges Of Post-Acute Stroke Rehabilitation In Obese Patients : A Case Series.2. Overview Of Ischemic Stroke Among End Stage Renal Failure Patients On Hemodialysis.3. Driving Advice Documentation On Discharge Letters For Cardiac And Other Patients.4. Preparedness In Stroke Caregiving Among Family Caregivers.5. Acute Stroke Unit of Seberang Jaya Hospital – One Year Experience.6. UKM Medical Center Stroke Unit: Team Recruitment of Patients To The AVERT DOSE Trial During The COVID-19 Pandemic.7. Successful Thrombolysis Beyond Guidelines: A Case Series.

Approach to Ischemic Stroke

An approach to managing acute ischemic stroke includes recognition, investigations, treatment, and secondary prevention. Firstly, facial drooping, limb weakness and slurred speech are some common signs that should raise the suspicion for stroke. Upon presentation, investigations, including the national institute of health stroke scale and a CT head, should be done to rule out intracranial hemorrhage and diagnose an ischemic stroke. The treatment principles for an acute ischemic stroke focus on removing or dissolving the occlusion to maintain or reinstate perfusion of the brain. Finally, patients suffering ischemic stroke should be admitted to the acute stroke unit and monitored for complications. Basic medical management of comorbidities should also be considered to prevent subsequent ischemic episodes. This article will explain each of these processes in more detail to help develop a basic approach to the management of an acute ischemic stroke.

Challenges of Estimating Accurate Prevalence of Arm Weakness Early After Stroke

Background. Recent studies have reported lower statistics of upper limb (UL) weakness (48-57%) compared to widely cited values collected over 2 decades ago (70-80%). Objective. To explore potential factors contributing to the accuracy of prevalence values of UL weakness using a case study from a single regional centre. Methods. All patients admitted to the acute stroke unit with suspected diagnosis of stroke were screened from February 2016 to August 2017. Upper limb weakness was captured (a) prospectively using the Shoulder Abduction and Finger Extension (SAFE) score performed by unit physical therapists within 7 days post-stroke and (b) retrospectively via chart review using the National Institutes of Health Stroke Scale (NIHSS) arm score at admission and 24 hours post-admission. Results. A total of 656 patients were admitted with a first-ever stroke, and 621 (95%) individuals were administered the SAFE score. A total of 40% of individuals had UL weakness using the SAFE score (SAFE ≤8) at a mean time of 1.9 (SD 1.5) days post-stroke. In the same sample, 57% and 49% had UL weakness using the admission and 24-hour post-admission NIHSS arm score, respectively. Conclusions. The accuracy of population-level UL weakness prevalence values can be affected by weakness measure and score cut-off, time post-stroke weakness is captured, sample characteristics and use of single or multiple sites. Researchers using prevalence values for clinical trial planning should consider these attributes when using prevalence data for estimating recruitment rates and resource needs.

Differences in Characteristics and Ambulance Pathway Adherence Between Strokes and Mimics Presenting to a Large UK Centralized Hyper Acute Stroke Unit (HASU)

Background: In Greater Manchester (GM), prehospital clinicians use the Face Arm Speech Test (FAST) to identify suspected stroke patients alongside pathway exclusions. Within the centralized stroke service, patients with a suspected stroke are taken directly to a Hyper Acute Stroke Unit (HASU), often bypassing their local emergency department (ED). However, many of these patients are experiencing an illness that looks like a stroke but is not a stroke. The data collected in the prehospital setting is rarely used in research yet could give valuable insights into the performance of the pathway.Aim: To evaluate the presenting symptoms and final diagnoses of prehospital suspected strokes and to evaluate the adherence of prehospital stroke pathway exclusions.Methods: We analyzed data from all patients brought in by ambulance and admitted on the stroke pathway between 01/09/15 and 28/02/17. Patient demographics and all data recorded in the prehospital setting were evaluated to identify differences in stroke, TIA, and mimic patients. Pathway adherence was assessed according to whether the patient was local or out-of-area (OOA) and bypassed their local ED.Results: A total of 4,216 suspected strokes were identified: 2,213 (52.5%) had a final diagnosis of stroke, 492 (11.7%) experienced a transient ischemic attack (TIA), and 1,511 (35.8%) were stroke mimics. There were 714 (16.9%) patients that were identified as having at least one pathway exclusion or were FAST negative, of which 270 (37.8%) experienced a stroke. The proportion of strokes was significantly lower in those with a pathway exclusion (41.8 vs. 53.5%; p < 0.001) and the proportion of breaches tended to be comparable or higher in the local population.Discussion: There are high volumes of stroke mimics but identified differences indicate there is an opportunity to better utilize prehospital data. Ambulance clinicians were able to correctly overrule FAST negative results and the volume of these suggest that FAST alone may be too restrictive.

145 Improvement of Bowel Monitoring in the Acute Stroke Unit

Introduction Constipation can lead to complications such as pain, acute kidney injury and delirium. This problem is more apparent in patients who are aphasic or frail, such as those suffering from stroke or have cognitive impairments. However, early recognition and timely prescription of laxatives can help prevent these complications and prevent unnecessary Per-rectal examination and exposure from radiation with abdominal X-rays. Methods This is a Quality Improvement Project that was carried out in the Acute Stroke Unit in Aberdeen Royal infirmary looking at the effectiveness of bowel monitoring and suggesting methods for improvement with the addition of an end-of-bed stool chart. The aims of the stool charts were to aid junior doctors in timely laxative prescription and to guide fluid management. The project was carried out from April to July 2020 using the PDSA cycle and presented to MDT in the ASU. Results show a 100% improvement in bowel monitoring with 67% compliance rate of the new stool charts. A survey was carried out and results show that 90% of the nursing team preferred the new stool chart. In conclusion, I think that the new stool chart serves its purpose in improving patient management amongst junior doctors. It should be implemented as standard care protocol in the acute stroke unit and definitely can be applicable in other wards.

Clopidogrel resistance in stroke patients (The CRISP Trial)

Objective: To investigate the incidence of clopidogrel resistance in patients with acute ischaemic stroke and to evaluate whether there is an association between clopidogrel resistance and the occurrence of a further cerebrovascular ischaemic event using the vasodilator-stimulated phosphoprotein (VASP) index as a marker of clopidogrel resistance. Methods: It is a prospective cohort study that recruited 120 patients from the acute stroke unit at the Royal Liverpool University Hospital. All patients with confirmed acute ischaemic stroke had clopidogrel 75mg/day at discharge or after 14 days of acute stroke if deemed by the direct clinical team to be the most appropriate treatment. After at least 7 days of clopidogrel 75mg/day, all those patients fulfilling inclusion/exclusion criteria had phosphorylation of vasodilator-stimulated phosphoprotein (VASP) measured. If VASP measured ≥50% after ≥7 days of clopidogrel maintenance, these patients were deemed as ‘clopidogrel resistant’, while those with VASP <50% were deemed as ‘clopidogrel responder’. Statistical analysis was by univariable analysis which considered the association of each variable – diagnosis, age, duration of clopidogrel, VASP, days to VASP, and number of comorbidities – with the outcome. Risk of second stroke after a first at 6, 12 and 24 months was estimated using logistic regression. Results: No variables were significantly associated with risk of stroke at 6 months with clopidogrel resistance having no significant effect on likelihood of a further stroke compared to the no clopiodgrel resistance cohort (p value= 0.39). Results were similar at 12 months follow up. However, at 24 months VASP index was significantly associated with risk of a further stroke; each one unit increase in VASP was associated with a 3% increase in risk of stroke at 24 months (p value = 0.05, CI Interval of 1.00- 1.06). Conclusion: No variables were significantly associated with risk of further stroke at 6 months and 12 months after a first stroke. However, VASP was significantly associated with risk of further stroke at 24 months with increasing VASP leading to a higher risk of further stroke.

Doing nothing? An ethnography of patients’ (In)activity on an acute stroke unit

Health research has begun to pay increasing attention to inactivity in its broadest sense as lack of meaningful activity and boredom. Few studies however have taken a critical look at this phenomenon. We explore (in)activity drawing on ethnographic data from observations in an acute stroke unit and post-discharge interviews with stroke survivors and their families. Four themes emerged that explain patients’ (in)activity: (i) planned activities; (ii) ‘doing nothing’, (iii) the material environment of the unit; (iv) interactions with staff. Considering these themes, we seek to problematise received conceptual and methodological approaches to understanding (in)activity. We argue that (in)activity is best conceived not as lack of action or meaning, but as a situated practice encompassing both bodily and mental activities that reflect and reproduce the way in which life is collectively organised within a specific healthcare setting.