Stroke Signals 1

Stroke Signals

November 2017

I N S I D E T H I S I S S U E

1 Welcome to your news!

2 What is Organized Stroke Care?

3 Staff Learning Opportunities

4 Patient and Caregiver Stroke Education

5

6

Spotted and Reported

Quality and Best Practice

7 Patient/ Family Advisory Subcommittee

Coordinator’s Corner:

It’s hard to believe I have been in this acting

position since May and it’s now November!

It’s been a steep learning curve despite many

years working on the frontlines of the HPEI

OSCP. Who knew writing policy or talking about

standards and indicators could be so interesting! I

have truly gained a new appreciation of the work

behind the scenes.

I have been impressed by the many dedicated

people who commit to providing the best possible

care to our patients and families, whether it is

doing hands on care or by creating systems and

policies that enable high quality care.

Production of this publication came together

thanks to Ann Millar and Tina Davis. I want to

thank them for this and the many ways they

contribute to the HPEI OSCP.

Trish

Hello and Welcome to the first edition of Stroke Signals

This communication has been created to inform and update

personnel working within the HPEI Organized Stroke Care

Program (OSCP) regarding activities, initiatives and the people

who make up the program.

This publication will be an overview of what is happening in

HPEI OSCP and what new things are on the horizon.

We hope this publication will reduce the some of the challenges

of communicating in a diverse group of people working towards

the goal of excellence in care for persons who are affected by

stroke.

If you want to know more about any of the topics or if you have

suggestions or constructive criticism, please let us know how to

make this a bit of news you would like to continue seeing!

Contact the Stroke Coordination Office at (902) 368-6527 or by

email tlhelm-neima@ihis.org

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Components of the PEI OSCP include all areas within the continuum:

Stroke prevention (primary and secondary): The PEI OSCP partners with Heart & Stroke to support public awareness; the OSCP is reviewing its links with primary care and is reviewing secondary prevention across the continuum.

Hyperacute stage: Links with IEMS and the ER utilizing practices that minimize time to diagnosis and treatment in the early stages.

Acute Stroke Management: The role of the Provincial Acute Stroke Unit (QEH) is the medical and rehabilitation care to minimize complications, promote recovery and plan for the next stage of care.

Rehabilitation: Begins on the Provincial Acute Stroke Unit, (ICU’s and other locations if appropriate) and continues through a number of locations that assist with rehabilitation practices that depend on the survivors needs. The Provincial Stroke Rehabilitation Unit (QEH), the outpatient rehabilitation teams (Provincial Ambulatory Stroke Rehabilitation Clinic and the District Ambulatory Stroke Teams) provide goal based therapy from early in recovery and throughout survivor’s lives. These teams begin the early steps into community reintegration.

Community Reintegration: Community Reintegration is the return to desired roles and activities within the community. The care must integrate the survivor and family/ caregiver needs and abilities when

assisting in this later stage of recovery.

This graphic illustrates the transitions through the PEI Organized Stroke Care Program emphasizing the role of the Stroke Navigator.

WHAT IS ORGANIZED STROKE CARE?

It is a system of care that is built on evidence-based best practices in assessment, diagnosis and

management of people who have had a stroke or transient ischemic attack that promotes optimal recovery

and reintegration. The system of care crosses the stroke continuum and the procedures, protocols, policies

are designed to ensure the stroke survivor and their families / caregivers received the most appropriate care

within the most appropriate setting at the right time. The care is evaluated within a quality management

framework with ongoing efforts to improve the delivery of care.

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FEATURED INITIATIVE:

Mark your Calendar!

2018 PEI Stroke

Conference

May 10th-11th 2018

Holland College!

Staff Learning Opportunities

Are you familiar with the online Provincial Stroke Services

Orientation in the Health PEI Staff Resource Centre?

Resources continue to be updated to reflect the evolving work within

Organized Stroke Care.

Check it out at http://www.healthpei.ca/src/stroke

Hemispheres is a Stroke Competency Series:

It is comprised of seven comprehensive modules providing current

best practices and consistent 24/7 education. This online education

includes visuals, animations, and interactivity to increase

understanding and promote retention as well as NIH Stroke Scale

Training and Certification. Talk to your manager about whether this

training is right for you.

Did you know that monthly professional development is available

via Health PEI’s Telestroke system?

Videoconferencing equipment is available from Souris, PCH, Western

or O’Leary sites. An easy connect process, the equipment provides

very clear sound and picture.

Colleagues within Organized Stroke Care share their expertise on

various topics. Consult the online calendar on the Stroke Orientation

website to discover upcoming topics.

Pre-registration is required.

For more info or to register, contact Ruth Mills, Nurse Coordinator

Provincial Ambulatory Stroke Rehabilitation Team:

902-894-2060 rmmills@ihis.org

DID YOU KNOW?

5 HPEI staff representing various departments within the Organized Stroke Care Program

attended the National Stroke Congress in September 2017

They include:

Janna Adams Glenna Bakker Maridee Garnhum Trish Helm-Neima Acute Stroke Unit Acute Stroke Unit Inpatient Rehabilitation Unit Provincial Stroke Coordination

Nora Johnston Grant MacLeod Ruth Mills PCH Stroke Prevention Clinic Provincial Ambulatory Stroke Rehabilitation Clinic

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Patient and Caregiver

Stroke Education

DID YOU KNOW?

A general stroke education session for patients & families

is offered the first Wednesday of each month from 2:30-

3:30pm.

Class is held in Physical Medicine Dept. at QEH, with the

ability for patients and families to participate by video-

conference from:

PCH

Souris

O’Leary

Alberton

The same presentation is offered weekly unless a specific

topic is requested.

This is not meant to replace the one on one education

provided to patients and families but can be

reinforcement to anyone who requires further

information.

This is a highly recommended session for patients on

acute stroke unit who are discharged after a short stay.

Examples of Topics:

Basic Anatomy, Physical & emotional changes, Diet

information

For more info or to register:

Contact Ruth Mills, Nurse Coordinator

Provincial Ambulatory Stroke Rehabilitation Team:

902-894-2060

rmmills@ihis.org

11thAnnual

Stroke Congress

Montreal, Canada

October 17th-20th, 2018

For the first time in over 12 years, The World Stroke Congress (WSC) will be returning to North America.

International Experts and colleagues will share the latest science, offer exciting sessions with a taste of French Canadian Culture!!

For more information visit,

http://www.worldstrokecongress.org/2018

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SPOTTED & REPORTED

Trevor Lynch has been a Speech Language Pathologist with the

Organized Stroke Care Program since 2009. His positive approach and

gentle support is appreciated by patients, caregivers, and colleagues

alike. Over the years, he has continued to hone his skills and knowledge

to provide individualized treatment to those whose language and

swallowing are affected by stroke. After working on the Provincial Stroke

Unit, Trevor now works part-time with both District West Ambulatory

Stroke Rehabilitation and PCH's Inpatient Units. Recently, we discovered

that he used Augmentative Communication Software to program an iPad

for one of his clients, turning it into a customized, speech

output, communication system. We caught up with him to learn more

about it.

Q: Why did you decide to pursue this project with this individual?

What goal were you trying to achieve?

A: This gentleman is young, he's familiar with technology, he knows his way around Apple devices and he

came to us as a great user of a low-tech communication aid (a compilation of pictures and phrases). We

went through the process of accessing the S-LP at Stan Cassidy Centre's Augmentative Communication

Clinic (Bill Wallace) for some direction. With Bill's help (by way of joint, televideo sessions), we slowly

updated and duplicated his low tech resource, turning it into a higher-tech communication aid. The goal of

any augmentative/alternative communication work is always the same . . . helping people

become effective, interactive and independent communicators.

Q: What is/was the greatest challenge with

this project?

A: Time. Learning how to use the

software/programming the iPad was an

incredibly time consuming process.

Q: What is/was the greatest reward?

A: Seeing this gentleman access the

device. When the iPad 'speaks' a message that

he selects, he's often able to repeat parts of

what the iPad says for him. In a way, the iPad

models it

Q: How do you see this project evolving or

being applied to meet future needs?

A: The great thing about these higher-tech communication aids is that they are so easily modifiable when

the core templates are in place. Vocabulary can be added/removed/updated pretty easily. Users/family can

sometimes be taught to do it. Also, now that we've developed a comprehensive set of core templates, with

a bit of tweaking, they can probably be used with another stroke client in the future

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QUALITY and BEST PRACTICE What is Stroke Distinction?

The Accreditation Canada Stroke Distinction program was launched in March 2010. Developed in partnership with the Canadian Stroke Network (CSN), the comprehensive Stroke Distinction program incorporates standards of excellence, Canadian Best Practice Recommendations for Stroke Care (strokebestpractices.ca), and in-depth, stroke-specific performance indicators and protocols. An on-site visit is conducted by expert evaluators with extensive practical experience in stroke services.

Following the successful completion of the Stroke Distinction process, an organization receives a Stroke Distinction Award that is valid for four years. At the end of the four years, the organization begins a new distinction cycle.

Stroke Distinction is a long term ongoing Quality Improvement process. It includes assessment of specific standards, indicators, protocols, innovative initiatives, and patient/caregiver education. Standards of Excellence in the Stroke Distinction program address the following three areas: 1. Integrated System of Services 2. Acute Stroke Services 3. Inpatient Stroke Rehabilitation Services. Our HPEI Organized Stroke Care Program (HPEI OSCP) will be assessed on all three sets of standards. Performance Indicators Throughout the Stroke Distinction process, organizations are required to collect and submit data for specific indicators, meeting minimum performance thresholds for a proportion of these. Sample indicators include: median time to administration of acute thrombolytic agent; proportion of clients treated on stroke unit; proportion of acute stroke clients discharged to inpatient rehabilitation Where performance indicator thresholds are not met, an action plan with performance targets is developed to guide improvement and indicator data must be regularly submitted between onsite surveys. Protocols Implementing stroke protocols is a key component of excellence in stroke services. Using protocols helps services remain consistent, high quality, and evidence based. There are a number of protocols that apply to the hyperacute/ acute and inpatient rehabilitation stages of care. To achieve an award of Distinction, organizations must ensure that 60% of the protocols are adopted and implemented by stroke services. The HPEI OSCP has implemented all of the required protocols. We will need to provide evidence that they are being utilized as intended.

Excellence and Innovation The Accreditation Canada programs require that organizations demonstrate the full implementation of projects or initiatives that align with best practice guidelines, and that they use the latest knowledge and integrate evidence to enhance the quality of stroke services. Examples include projects that improve communication at transition points, bolster the delivery of comprehensive patient care, and address tissue plasminogen activator (tPA) rates and response times. Eac h organization or stroke network (regardless of the number of sites) is expected to choose one to two stroke projects. The HPEI OSCP has chosen our Telestroke Rehabilitation Program as our special project to demonstrate innovation and excellence. Client and Family Education

Client, family, and caregiver education is an integral part of stroke care and should be addressed across the continuum. Education is an ongoing and vital part of the recovery process for stroke and must reach the survivor, family members, and caregivers. Stroke education supports coping and self-management, building skills for clients and caregivers that can reduce depression and the perceived burden of stroke, and improve the stroke patient’s quality of life. The information provided at each phase of care (acute, rehabilitation, community reintegration, and long-term recovery) should be relevant to the client’s and the family’s changing needs. Simply distributing information is not sufficient; instead, client education must be interactive. During the on-site visit, each site seeking Stroke Distinction must provide the evaluators with evidence of successful client and family education.

Currently (November 2017) the Stroke Education working group is reviewing the state of stroke education across the continuum. We have a provincially approved online education charting form capable of capturing multiple encounter information regarding the types and responses to the education being provided.

Stroke Distinction Task Group

The Stroke Distinction Task Group is comprised of individuals from across the stroke continuum who have the responsibility for ensuring that the processes, protocols, documents, and data are meeting the required standards and performance thresholds. Education and support of team members who work in the many areas of the HPEI OSCP is an important component of the work.

Stroke Distinction Task Group members are: Trish Helm-Neima, Stroke Coordinator (chair), Tim Burnley, Dr. Charles Duffy, Maridee Garnhum, Christine Handrahan, Dr. Ed Harrison, Margie Kays, Carolyn MacPhail, Jeremy Measham, Beth Pizio, Kelley Rayner, and Kim Wood.

For more details regarding Stroke Distinction, please contact Trish Helm-Neima, Provincial Stroke Coordinator tlhelm-neima@ihis.org

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STROKE PATIENT & FAMILY ADVISORY SUBCOMMITTEE

The Stroke Patient and Family Advisory Subcommittee (SPFAS) is being formed to ensure the patient and

family perspective is embedded in the PEI Organized Stroke Care Program. Stroke survivors and caregivers

can share their lived experiences, perspectives, and feedback with system leaders as advisors to:

Provide guidance and advice to improve patient and family-centred stroke care across the continuum

Provide input and feedback in the planning and operation of specific initiatives as part of the Provincial

Stroke Steering Committee’s vision for the PEI Organized Stroke Care Program

Their input will be carried forward to the Provincial Stroke Steering Committee and respective

subcommittees. The contribution of patient and family advisors will help to ensure other clients receive the

best stroke care possible. Please encourage potential advisors to apply through Engage PEI ASAP:

www.princeedwardisland.ca/en/information/executive-council-office/health-pei-volunteer-patientfamily-

advisors.

For more info, contact Stroke Navigator, Ann Millar: aemillar@ihis.org

902-620-3506/ 1-844-871-0634 (toll-free)