canadian best practice recommendations for stroke care: 2008 an introduction
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Canadian Best Practice Recommendations for Stroke Care: 2008 An Introduction. Today’s Discussion. Overview of the Canadian Stroke Strategy Overview of the Canadian Best Practice Recommendations for Stroke Care Highlights of update for 2008. ~ 50,000 strokes/year. 300,000 Canadians - PowerPoint PPT PresentationTRANSCRIPT
Canadian Best Practice Recommendations for Stroke Care: 2008An Introduction
Today’s Discussion
Overview of the Canadian Stroke Strategy Overview of the Canadian Best Practice
Recommendations for Stroke Care Highlights of update for 2008.
Impact of Stroke in Canada
Someone has a stroke
every 10 minutes
~ 50,000 strokes/year
300,000 Canadians living with stroke
20% chance of second stroke within 2 years
16,000 Canadians die from stroke
each year
Price Tag:$3.6 billion annually
For every symptomatic stroke there are 9 ‘silent’
strokes resulting in cognitive impairment
Canadian Stroke Strategy
Provides a framework to facilitate the widespread adoption of evidence-based best practices across the continuum of stroke care focusing on two levels of change: At the national level At the provincial/territorial level.
PreventionPrevention
Clinics
TreatmentProtocols, Stroke
Teams
RehabilitationPersonal Care
Plans
Best Practice Guidelines and Standards of Care
Professional Development
• Decrease burden of stroke • Improve quality and efficiency of care
• Establish Canada as an international leader
Provincial/Territorial/Regional Implementation of Best Practice
National Platforms to Support Provincial/Territorial/Regional Strategies
Public Awareness
ReengagementCoordinated Support
Information/Evaluation
Coordinated Research
The Canadian Stroke Strategy Model
PreventionPrevention
Clinics
TreatmentProtocols, Stroke
Teams
RehabilitationPersonal Care
Plans
• Decrease burden of stroke • Improve quality and efficiency of care
• Establish Canada as an international leader
Provincial/Territorial/Regional Implementation of Best Practice
National Platforms to Support Provincial/Territorial/Regional Strategies
ReengagementCoordinated Support
The Canadian Stroke Strategy Model
Public Awareness
Best Practice Guidelines and Standards of Care
Professional Development
Information/Evaluation
Coordinated Research
National PlatformsBest Practices and Standards
Goal is to transform stroke prevention and care.
Development and dissemination of evidence based best practices and guidelines along the stroke continuum of care.
Targeted strategies to increase uptake and implementation
Knowledge translation strategy underway Long term goal to synthesize more
comprehensive list of Canadian best practices and standards with focus on effective dissemination and uptake.
National Platforms
Information and Evaluation
Establish evaluation framework. Focus on data access, surveillance and monitoring. Development of evidenced based performance
measures to support monitoring and evaluation of all best practice recommendations.
Collaborative initiatives with CIHI and PHAC. Evaluation of stroke strategy overall.
National Platforms
Professional Development and Training To coordinate and enhance professional
development and training opportunities across the continuum of stroke care.
Develop point-of-care tools to support and facilitate implementation of best practice recommendations for stroke care.
Priority areas identified as focus for creating educational materials.
National Platforms
Coordinated Research Leadership from CSN, HSFC in partnership with
CIHR, Canadian Stroke Consortium, and others To assess current status of stroke research To identify and address gaps that exist in the
evidence base
Public Awareness Leadership from Heart and Stroke Foundation of
Canada Public Awareness focus on effective ways of
ensuring that the public knows what a stroke is, risk factors, signs and symptoms and the appropriate response.
Your Provincial Model
Key Provincial Stroke Strategy Resources Provincial Coordinators Heart and Stroke Foundation Contacts Canadian Stroke Strategy
Expertise in strategy development and implementation, best practices and evaluation
Standardized guidelines and tools Canadian Stroke Network
Links with research and clinical expertise across stroke continuum
Establishing Best Practices for Stroke Care in Canada
Alignment leads to great things!!
CDA
Canadian Stroke Network
CanadianCanadianStroke StrategyStroke Strategy
CANN
SCORE
Provincial Initiatives
Stroke Survivors
Community Care
Rehabilitation – all disciplines
CSQCS
Accreditation
Public Health Agency of Canada
CIHI
CHEPMOHLTC
HSFC
EBRSR
Primary CareHealth Promotion
CAEP
CFPC
Canadian Stroke Consortium
Canadian Best Practice Recommendations for Stroke Care Synthesis of best practice
recommendations across continuum Address critical topic areas Commitment to update every two years First edition released in 2006 Current update released in 2008
Refined process Expansion of recommendations www.cmaj.ca December 2, 2008
Best Practice Recommendations for Stroke Care: Development and Update Process Utilized conceptual framework to guide
identification, selection and development Led by a subgroup of the Best Practices and
Standards Working Group Managed by the Performance & Standards
Specialist from the Canadian Stroke Network Identification of interprofessional stroke care
experts for task groups and panel membership
Best Practice Recommendations for Stroke Care: Development and Update Process Criteria Identification:
Supported by the highest level of evidence and/or considered essential to delivering best practice in stroke care.
Integral to driving important health system change
Aligned with other Canadian stroke related recommendations
Reflect the continuum of care
Best Practice Recommendations for Stroke Care: Development and Update Process Extensive literature scan of primary stroke
research reports, international stroke related guidelines and recommendations
AGREE tool for appraisal of guideline quality Content review of core reference guidelines
conducted to identify list of critical topic areas Additional stroke topic areas identified Tables developed to compare content of
recommendations across guidelines
Review of Existing Guidelines
ASA/VADoDASA/VADoD
RCPRCP
AustraliaAustralia
New ZealandNew Zealand
CSQCSCSQCS
SIGNSIGN
CHEPCHEP HSFOHSFO
SCORESCORE
CDCDAA
Best Practice Recommendations for Stroke Care: Development and Update Process Expert task groups convened to review
recommendation tables and research evidence Canadian recommendations were drafted and
updated based on consensus of task groups National Consensus panel to select and refine final
recommendation set External review by stroke experts and peer review
publication process (CMAJ) Development of Performance Measures by CSS
Information & Evaluation Working Group
Reorganization of Recommendations 2008
2006RECOMMENDATIONS
1. Public Awareness
2. Patient and Caregiver Education
3. Stroke Prevention
4. Acute Stroke Management
5. Stroke Rehabilitation
6. Follow-up and Community Re-engagement
2008
RECOMMENDATIONS
1. Public Awareness and Patient Education
2. Stroke Prevention
3. Hyperacute Stroke Care
4. Acute Inpatient Stroke Management
5. Stroke Rehabilitation & Community Reintegration
6. Selected Topics in Stroke Management
Recommendation Format
Best Practice Recommendation
Rationale
System Implications
Performance Measures
Measurement Notes
Summary of Current Evidence
Highlights of the 2008 Update
Revisions to the 2006 recommendations: Minor edits and updates for 21 of the original
24 recommendations. Recommendation related to computed
tomography scanning and carotid imaging were combined to one for Neurovascular Imaging.
Community Rehabilitation recommendation was refocused to include both outpatient and community rehabilitation services.
Highlights of the 2008 Update Additional Amendments:
Discharge planning integrated Pediatric Stroke issues introduced
New Recommendations: Emergency medical services care of stroke
patients prior to hospital arrival or in transport between hospitals
Acute management of transient ischemic attack and minor stroke
Components of acute stroke management to minimize complications
Vascular cognitive impairment and dementia
1.0 Public Awareness and Patient Education Public awareness and
responsiveness Patient and family
education 2.0 Prevention of
Stroke Lifestyle and risk factor
management Blood pressure
management Lipid management Diabetes management Antiplatelet therapy Antithrombotic therapy
for atrial fibrillation Carotid intervention
3.0 Hyperacute Stroke Management Emergency medical
services prior to hospital arrival
Acute management of transient ischemic attack and minor stroke
Neurovascular imaging Blood glucose Acute thrombolytic
therapy Acute Aspirin
therapy Management of SAH
& ICH
Canadian Best Practice Recommendations for Stroke Care (2008) Topic Areas
Canadian Best Practice Recommendations for Stroke Care (2008) Topic Areas 4.0 Acute Stroke
Management Acute stroke unit care Components of acute
inpatient care 5.0 Stroke Rehabilitation
and Recovery Initial stroke rehabilitation
assessment Provision of inpatient
rehabilitation Components of inpatient
stroke rehabilitation Outpatient and community-
based rehabilitation Follow-up and evaluation in
the community
6.0 Selected Key Topics in Stroke Management Dysphagia assessment Identification and
management of post-stroke depression
Vascular cognitive impairment and dementia
Shoulder pain assessment and treatment
Implementation Tools and Resources Point of Care Tools
Acute Stroke Management Resource Toolkit for the Canadian Best Practice Recommendations
for Stroke Care (2006) (2008) Pocket Reference Cards
o Cranial Nerves o Common Stroke Presentationso Functions of the brain o National Institutes of Health Stroke Scale o Canadian Neurological Scaleo Stroke Prevention Card
Faaast FAQ’s for Nurses National Professional Education Atlas
Available at: www.heartandstroke.ca/profed
Best Practice Standards Dissemination National release of Canadian Best Practice
Recommendations update in CMAJ on December 2, 2008 (www.cmaj.ca)
Website www.canadianstrokestrategy.ca Broad dissemination across provinces, national and
international meetings Individual consultation within provinces to address
regional and local issues, challenges and strategies for dissemination and uptake
Consultation with national and provincial professional associations and groups
Inclusion in stroke related newsletters: National Stroke Nursing Council newsletter Canadian Stroke Network Brainwaves
Tips Related to Generally Effective Strategies for Dissemination Educational outreach visits Interactive educational meetings Multifaceted interventions including two or
more of the following: Audit and feedback Reminders Local consensus processes Social marketing
(Ian Graham, 2006)
Ongoing Development of Canadian Stroke Recommendations Suggested topics to consider for future
updates: Family and caregiver support Management of post stroke seizures Discharge planning Management of patients who experience a stroke while in
hospital for other conditions Telemedicine for stroke care across the continuum Primary management of atrial fibrillation in patients who
have not experienced a stroke Management of patients with communicative disorders
resulting from stroke Recommendations for specific populations, such as
aboriginal groups, visually impaired