Sylvia’s Story
Interlude 1A Wow! What’s happening to me? As I went to bed at 10, I had headaches and vision problems. When I woke up nothing had changed. I knew something was wrong. I called Judy to take me to take me to the doctor, but she could hardly understand me. The staff at the doctor’s office told me they thought I was having a stroke. So they called 911. |
You are on duty in the doctor’s office that day (the PCN ).
What do you need to tell EMS?
- Review the signs of stroke that the patient demonstrates.
- Time of onset ( last seen normal)
- Did patient wake with stroke?
Explain last seen normal
Insert infographic of stroke symptoms here
Which stroke screening tool do you use?
Insert screening tool have learner check off the relevant checkmarks that apply to Sylvia
Should you call a specialist for a consult?
( No this will likely delay time sensitive stroke treatment. )
Remember sensitive stroke treatment is time sensitive.
Sylvia is delivered to ED. |
As the receiving staff member, what info do you need from EMS?
- EMS verbal + written report
- Is patient stable? Manage ABCs
- Signs and symptoms Time of onset
Insert EMS form here for learners (ePCR talk to Dwight and Bryan)
Interlude 1B Now I’m lying in bed in the ED. After a brain MRI, they say I have a stroke. They want to admit me to the stroke unit for tests and therapy. I wonder what to expect? |
Sylvia has the following concerns:
Can you help her with these questions?
- How did this happen to me? I thought strokes were for old people.
- For more information go to heart and stroke foundation
- Why am I being admitted to the stroke unit?
- What care can I expect for my stroke ?
Providing info to assist with these questions from:
A Patients Guide to Canadian Best Practices Recommendations for Stroke Care
heart and stroke foundation
http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483933/k.CD67/Stroke.htm
Is there something we have to do between ER and Acute care ?
Interlude 2 After 4 days in hospital, Sylvia is anxious to get home and return to work. She has been told that her neck arteries are open and her bloodwork is normal. There were no abnormalities noted on her ECG or during cardiac monitoring. At this point they cannot tell her why she had the stroke. She is scheduled for an ultrasound of her heart later today. Sylvia feels she is improving, can’t afford more time off work, and plans to discharge herself tomorrow if the doctor won’t let her go. She is worried about getting around as the Dr. said she couldn’t drive. |
To assist Sylvia in her stroke / healthcare journey, assist her
SYLVIA: When will I get better?
NURSE: To better understand this you need to know how you get better:
- Sylvia will need the roles of different therapists and team members, community services, once she is back within the community
- Information on stroke recovery, timelines, activities to promote recovery
SYLVIA: Will I be able to work?
(NURSE: ) What transitions will assist Sylvia in answering this question?
- Referral to ESD or other out-patient stroke assessment services for neuropsychology testing and Return-to-Work assessment
- Contact employer for a discussion on modified RTW duties
SYLVIA: Will I be able to function at home on my own?
(HCP )What can the healthcare professional do to assist Sylvia in transitioning to returning to her home?
- Propose a home assessment
- Refer to Homecare
- Assist patient to write a list of support people to contact
- Refer to out-patient therapy programs
SYLVIA: can I still drive?
(HCP) What can the HCP do to answer Sylvia’s questions about driving?
- Refer to Drive-Able or other driver assessment programs
- Help patient plan alternative transportation modes
- Discuss the impact on insurance, etc. if patient drives with a disability and is involved in an accident
Criteria for ESD:
ahs.ca/info/service.aspx?id=1068060
Interlude Final Sylvia was advised that she needs therapy for her gait disturbance, residual vision deficits, and mild speech problems. Sylvia feels she can just recover by returning to her usual activities of daily living. She misses her friends and just wants to “get back to normal”. The team works with Sylvia to arrange a weekend at home ( formerly know as a pass) to see if she can manage on her own. The stroke neurologist discharges Sylvia with a referral to the Stroke Early Supported Discharge Program. She is also supposed to follow up with her Primary Care physician and cardiology for a loop recorder. ???? do we need this?? |
Send me the pass - self report card
Tie it in with pass info might be better fit.
- How can we support Sylvia’s Pass and Transition to returning her life back to her home?
- Education for Self management
- Make sure she can take medications
- A Guide for When I Leave the Hospital: self document the following:
- My Medical Issues
- Important phone numbers and contacts
- Medication list and diary
- Appointment diary
- Questions for my doctor
FINAL QUESTION
2. How do I refer her to ESD Early Stroke Discharge team ? form is sent ----- can they take her or not
. . . Now she is Accepted to ESD
3. How Do we Transition Her to the ESD?
- Send Discharge summary ( likely needed )
4. Visit family doctor
- Send Discharge summary
- Post stroke checklist