Promulgation on In-patient Stroke Awareness in PMH

Abstract Description

Proposed Topic (Most preferred): :

Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)

Authors (including presenting author) :

Lam LP(1), Cheung CCC(1), Kwong CL(2), Chin LSA(1), Lam MW(1

Affiliation :

1Integrated Neurosurgery and Neurology Ward, Department of Neurosurgery, Princess Margaret Hospital (PMH), Kowloon West Cluster 2Department of Medicine & Geriatrics, Caritas Medical Centre, Kowloon West Cluster

Introduction :

Stroke is the second leading cause of death worldwide and the third most common of long-term disability. Stroke not only occurs outside hospital but also occurs during hospitalization in a patient originally admitted for another diagnosis or procedure. However, compared with patients presenting to the emergency department with an acute ischemic stroke, inpatient strokes are delayed in triggering of reperfusion assessment and in receiving thrombolytic therapy. One of the reasons is that general nursing staff may not be familiar with stroke symptoms and inpatient stroke workflow. "Time is brain", early detection of acute stroke plays a major role in the outcome of ischemic stroke. Patients with prompt interventions such as thrombolysis and mechanical thrombectomy greatly reduce disability and stroke associated complications. It is important for nursing staff to recognize stroke and employ prompt actions. The sooner a person receives treatment for a stroke, the less damage is likely to happen.

Objectives :

(1) To promulgate inpatient stroke awareness (2) To strengthen knowledge of nursing staff of stroke symptoms (3) To introduce the up-to-date in-patient stroke workflow

Methodology :

(1) Launch of BEFAST screensaver BEFAST screensaver was launched on 1 Mar 2023. Since computers are widely used in hospitals, a screensaver can act as a promotional purpose to strengthen knowledge of stroke symptoms. Besides, like embedded advertisements, timely remind nursing staff always "be fast" when alert inpatient stroke. (2) Revised inpatient stroke workflow PMH stroke team receives in-patient stroke triggers from various hospitals, including PMH, KCH, LKB and NLTH rehabilitation units. Inpatient stroke workflow was revised as 24-hour reperfusion therapy became available from 30 July 2023 in PMH. Ischaemic stroke patient with large vessel occlusion and with stroke onset within 6 hours may be eligible intra-arterial mechanical thrombectomy. The revised workflow provides a clear pathway for all departments and reminds nursing staff not to hesitate to contact stroke nurses for any suspected stroke cases. (3) Onsite briefing to all wards of related hospitals Onsite briefing to all wards of related hospitals by stroke nursing team was done in Oct 2023. It aimed to convey information of BEFAST and to introduce the inpatient stroke trigger workflow to all nursing staff of different departments. Related information will be further delivered within the ward to the staff who are not able to attend. (4) Cluster-based promulgation talk Cluster-based promulgation talk was organized by KWC ASCDCC to emphasize the importance of early detection of stroke by BEFAST, to introduce inpatient stroke workflow and to answer enquiry of nursing staff.

Result & Outcome :

* The promulgation interventions were effective in increasing nursing staff awareness in inpatient stroke. Compared with 2022 and 2023, the number of triggers of inpatient stroke over the number of total reperfusion assessment calls increased 3% in PMH. In 2023, around 10% of total reperfusion calls received are from inpatient triggers, and 22% of the inpatient trigger cases were eligible for receiving reperfusion therapy. * Positive feedback was received from nursing staff on onsite briefing and cluster-based promulgation talk. The briefing and talk helped to increase staff awareness of inpatient stroke and for early stroke triggers.