Patient Safety in a Box: Implementation and Evaluation of the Emergency Box in Geriatric and Parkinson Patients

In an industrial society, the proportion of geriatric people increases with rising age. These people are likely to use polypharmacy and experience medical emergencies. However, their emergency care can be complicated by unclear comorbidities and medication. The aim of this prospective interventional study was to assess the demand for a drug safety tool in clinical practice and to analyze whether the emergency box can improve acute care in a geriatric cohort. Therefore, emergency room (ER) doctors in a German tertiary hospital recorded the number of geriatric patients lacking medical information and its impact on diagnostics/treatment. Furthermore, the emergency box was distributed to patients on the neurological ward and their current drug safety concepts were assessed. After 6 months, we evaluated in a follow-up whether the tool was helpful in emergency cases. Our study revealed that 27.4% (n = 28) of the patients came to the ER without their medical information, which caused a relevant delay or possible severe complications in 11.8% (n = 12). The emergency box was perceived as easily manageable and 87.9% (n = 109) of the participants wanted to keep it after the study. Subjectively, participants benefitted in emergencies. In conclusion, the emergency box is a cheap tool that is easy to use. It can save valuable time in emergencies and increases the safety of geriatric patients.

Causes for Emergency Hospitalization of Neurological Patients With Palliative Care Needs

Background: Acute and unexpected hospitalization can cause serious distress, particularly in patients with palliative care needs. Nevertheless, the majority of neurological inpatients receiving palliative care are admitted via an emergency department.Objective: Identification of potentially avoidable causes leading to acute hospitalization of patients with neurological disorders or neurological symptoms requiring palliative care.Methods: Retrospective analysis of medical records of all patients who were admitted via the emergency department and received palliative care in a neurological ward later on (n = 130).Results: The main reasons for acute admission were epileptic seizures (22%), gait disorders (22%), disturbance of consciousness (20%), pain (17%), nutritional problems (17%), or paresis (14%). Possible therapy limitations, (non)existence of a patient decree, or healthcare proxy was documented in only 31%. Primary diagnoses were neoplastic (49%), neurodegenerative (30%), or cerebrovascular (18%) diseases. Fifty-nine percent were directly admitted to a neurological ward; 25% needed intensive care. On average, it took 24 h until the palliative care team was involved. In contrast to initially documented problems, key challenges identified by palliative care assessment were psychosocial problems. For 40% of all cases, a specialized palliative care could be organized.Conclusion: Admissions were mainly triggered by acute events. Documentation of the palliative situation and treatment limitations may help to prevent unnecessary hospitalization. Although patients present with a complex symptom burden, emergency department assessment is not able to fully address multidimensionality, especially concerning psychosocial problems. Prospective investigations should develop short screening tools to identify palliative care needs of neurological patients already in the emergency department.

Adaptation of the Aphasia Bedside Check for Russian

The Aphasia Bedside Check for Russian (ABC-Ru) is a screening test that allows the medical staff of a neurological ward to detect speech/language disorders in the first days post-stroke onset. To evaluate whether this test follows modern psychometric standards, we performed two studies. In Study 1, we reported the results of the standardization of the ABC-Ru in a clinical group of people with chronic speech/language disorders (N = 80) and a cohort of neurologically healthy individuals (N = 120). In Study 2, we validated the results in a group of people in the acute post-stroke period (N = 20) with and without speech/language disorders. According to the results of the study, the ABC-Ru can be considered as a valid instrument and can potentially be used in neurological departments for the screening of speech and language disorders

Analysis of Nursing Clinical Practice of Oral Hygiene on Patient with Hemorraghic Stroke – A Case Study

<p><strong>Objective</strong>: The purpose of this case study was to analyze the oral hygiene intervention performed by nurse in stroke hemorrhagic patient in neurological ward</p><p> </p><p><strong>Methods:</strong> .Oral hygiene interventions were performed by using 0.2% chlorhexidine twice daily for seven days. This case study used oral health assessment tool (OHAT) which the measurements were taken before and after the intervention every day</p><p> </p><p><strong>Results</strong>: There was a decrease in oral hygiene assessment score from 9 to 1 which implied an improvement in oral hygiene condition. This study also showed that family of stroke patient was able to perform oral hygiene practice to the patient after simulation performed firstly by nurses</p><p> </p><p><strong>Conclusion</strong>: The study recommends that oral hygiene by using 0.2% chlorhexidine needs to be delivered routinely by nurses and continues by the family at home care.</p><p> </p><p><strong>Keywords</strong>: chlorhexidine 0.2%, oral hygiene, stroke.</p>

Stroke Clients’ Satisfaction as The Nursing Care Quality Benchmark in Neurological Ward

<p><strong>Objective: </strong>Stroke clients’ satisfaction while being hospitalized need to be concerned because it will affect their follow- up treatment. This study was conducted to determine stroke clients’ satisfaction toward nursing care in neurology ward.</p><p><strong>Methods: </strong>This study was cross-sectional approach performed in 25 hospitalized patients consecutively at the neurology ward.</p><p><strong>Results</strong>: The result shows 60% of stroke clients were satisfied with the nursing care in neurology ward, especially for the assurance dimension (76%).</p><p><strong>Conclusion: </strong>Suggestion for the hospital is to optimize the nursing care quality in the neurology ward.</p><div><p class="Keywords"><strong>Keywords</strong>: Nursing care; satisfaction; stroke</p></div>

Francis Rohmer: from the neurological ward to Dachau and back

ABSTRACT The author presents a brief synopsis of the life and works of Professor Francis Rohmer, a French neurologist whose great relevance to the development of the French Neurological Society is only outshined by his humanistic role, in spite of harsh conditions, when a prisoner at the Dachau Concentration Camp in Germany, during World War II.

Post-stroke dysphagia: an analysis of the competences of the care processes of the interdisciplinary team

ABSTRACT Objective: to analyze the competencies of the interprofessional team in the care of dysphagic stroke patients. Methods: an exploratory-descriptive, qualitative study. The research participants i.e., nursing technicians, nurses, physiotherapists, speech therapists and physicians that provided care to patients with stroke in the acute and subacute phase, were randomly selected. The study setting was a stroke unit and neurological ward of the neurology referral hospital for Ceará State, Brazil. Data collection was performed through a semi-structured and recorded interview. The recorded data were organized and analyzed, according to the thematic analysis technique proposed by Bardin. Results: based on the statements, three main categories were developed: “conceptualizing and identifying dysphagia”, “knowledge about the prevention of bronchoaspiration in stroke patients” and “bronchoaspiration as a complication of dysphagia”. The providers’ statements revealed that some experienced doubts and even unawareness about what dysphagia is. Conclusion: the present study showed a complexity of care for stroke patients with dysphagia. Therefore, this scenario reflects the need for continuing education in the service and for interdisciplinarity among professional categories.

HUBUNGAN ANTARA DERAJAT KEPARAHAN STROKE DENGAN KEJADIAN STROKE-ASSOCIATED PNEUMONIA

ASSOCIATION BETWEEN STROKE SEVERITY AND STROKE-ASSOCIATED PNEUMONIAABSTRACTIntroduction: Stroke-associated pneumonia (SAP) occurs in 5-26% and decreases the quality of life and clinical outcomes of stroke patients. One of the factors that affect the incidence of SAP is the stroke severity.Aims: To determine the association between the stroke severity and the incidence of stroke-associated pneumonia in the neurological ward of Dr. Hasan Sadikin Hospital, Bandung.Methods: This is an analytic retrospective (historical) cohort design study. The study population was stroke patients who were treated in the neurological ward of Dr. Hasan Sadikin Hospital, Bandung between 2014-2016. Exclusion criteria were patient with pneumonia other than SAP and using mechanical ventilation. Stroke severity was assessed using NIHSS (National Institute of Health Stroke Scale). Chi-square was used to determine inter-variable association.Results: Among 81 subjects, 24 were assessed as SAP (29.6%). The SAP prevalence were mostly male (58.3%), age group between 65-74 year old (41.7%) with hypertension risk (87.5%), stroke onset <48 hours, lesion location on left hemisphere, onset of SAP≥48 hours, and those with consciousness impairment. Those with high stroke severity tend to have higher risk of pneumonia 3.063 times compare to patients with low stroke severity.Discussion: There was a significant association between the severity of stroke and the incidence of SAP in the neu- rological ward of Dr. Hasan Sadikin Hospital, Bandung.Keywords: NIHSS, stroke-associated pneumonia, stroke severityABSTRAKPendahuluan: Stroke-associated pneumonia (SAP) cukup sering terjadi (5-26%) pada pasien stroke, sehingga menurunkan angka kualitas hidup dan luaran klinis. Salah satu faktor yang memengaruhi kejadian SAP adalah derajat keparahan stroke.Tujuan: Mengetahui hubungan antara derajat keparahan stroke dengan kejadian SAP di Ruang Rawat NeurologiRSUP Dr. Hasan Sadikin, Bandung.Metode: Penelitian analitik dengan desain kohort retrospektif (historikal) terhadap pasien stroke iskemik yang di rawat di Ruang Rawat Neurologi RSUP Dr. Hasan Sadikin, Bandung pada tahun 2014-2016. Kriteria eksklusi adalah pasien dengan pneumonia selain SAP dan menggunakan alat ventilasi mekanik. Derajat keparahan stroke dinilai menggu- nakan skor NIHSS (National Institutes of Health Stroke Scale). Uji korelasi Chi-square digunakan untuk melihat hubungan antar-variabel.Hasil: Didapatkan 81 subjek yang 24 orang di antaranya mengalami SAP (29,6%). Prevalensi SAP tertinggi pada laki-laki (58,3%) kelompok usia 65-74 tahun (41,7%) dengan faktor risiko hipertensi (87,5%), onset stroke<48 jam, lokasi lesi di hemisfer kiri, onset SAP≥48 jam, serta pada subjek dengan penurunan kesadaran. Subjek dengan derajat keparahan stroke berat memiliki risiko terjadinya pneumonia 3,063 lebih tinggi dibandingkan dengan derajat keparahan ringan.Diskusi: Terdapat hubungan yang bermakna antara derajat keparahan stroke dengan kejadian SAP di Ruang Rawat Neurologi RSUP Dr. Hasan Sadikin, Bandung.Kata kunci: Derajat keparahan stroke, NIHSS, stroke-associated pneumonia