Transcript Presentation 4 - GLRN stroke education

Stroke Education
An Evidenced Based Approach
Presented by
Elaine Siwiec, RN, BSN
April 8, 2010
Stroke Education
New York, March 5, 2009
The number of patients who do
not take secondary prevention
measures after having a stroke is
“alarmingly high”
Source: Ross J, Stroke 2009,10: 1161
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Importance of Recurrent Stroke
Makes up about 25% of all strokes
Recurrence rates as high as ~ 30%
over 5 years
Associated with substantial costs to
the health care system
Application of proper prevention
interventions provides an opportunity
to prevent subsequent stroke
Source: Roberts CS, Gorelick, Stroke 2009, 40: 1425-1432
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Stroke Education
Required by the Joint Commission
Personal risk factors for stroke
Stroke Warning Signs
Activation of EMS
Need for follow-up after discharge
New medications prescribed at discharge
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Stroke Education
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Disease Specific Patient
Satisfaction Survey
This was our first attempt to measure the
effectiveness of our education
Two Questions Related to Stroke Education
I can name my personal risk factors of stroke
I understand what I can do to reduce the risk
of another stroke
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Prevention Strategies
PROTECT – Preventing Recurrence of
Thromboembolic Events through
Coordinated Treatment
8 medication/behavioral secondary
prevention measures
Objective was to determine utilization
rates at 90 days after discharge
Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883
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Definition of Adherence for Each
Behavioral Goal (PROTECT)
Smoking Cessation – no smoking activity beyond 1
month
Exercise – moderate exercise defined by walking,
running or swimming for 30 minutes at least 4 days
per week or PT or OT of a similar duration and
frequency.
Diet – 5 servings of fruits and/or vegetables per
day, at least 2 servings of fish per week and at least
1 fiber-rich meal per day for 4 of 7 days per week.
Stroke Awareness – 911 awareness, able to name
at least 2 of their modifiable risk factors and aware
of at least 3 of 5 common stroke warning signs
Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883
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PROTECT RESULTS
Sept 2002 to Aug 2003
130 patients – results at 90 day follow-up
Antithrombotics = 100%
Statins = 99%
Importance of Calling 911 = 87%
Adherence to Diet = 78%
Adherence to Exercise = 70%
Tobacco Cessation = 83%
Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883
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PROTECT TOOLS
Bedside teaching
Patient self monitoring log
Information brochures
Handoff letters to primary physicians
Telephone interview abstraction form
Report score card
Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883
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Successful Strategies to
Reduce Stroke Risk
Studied the effect of simple advice vs.
brief educational intervention
Brief Intervention (BI) model
integrates motivational interviewing
with behavioral change
Source: Miller E T, Spilker J, Journal of Neuroscience Nursing, Aug 2003, 35: 215-222
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Six Key Ingredients Trigger
Motivation to Change (FRAMES)
Feedback: Patient receives info on current status
Responsibility: Patient assumes responsibility for the
change
Advice: Patient receives suggestions to help in the
change process
Menu: Patient receives a number of alternative
strategies for modifying the problem behavior
Empathy – Patient receives warm support and respect
Self-efficacy: Patient develops an “I can do this!”
attitude
Source: Miller E T, Spilker J, Journal of Neuroscience Nursing, Aug 2003, 35: 216
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Successful Strategies to
Reduce Stroke Risk
Each group received the same 30-minute
face-to-face health interview
The BI group received 15 minutes of more
individualized motivational counseling
encompassing the FRAMES strategies
Interventions were targeted according to
patient specific goals
A log was provided to track goal
achievement
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Successful Strategies to
Reduce Stroke Risk
The BI group received another 15
minutes interview at 4-6 weeks and 3
months
The BI group achieved a high number
of newly initiated stroke-risk reduction
behaviors
Source: Miller E T, Spilker J, Journal of Neuroscience Nursing, Aug 2003, 35: 215-222
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Stroke/TIA Education Materials Folder
If you have been diagnosed with stroke or TIA, it’s important to follow your doctor’s advice. The education
materials have been provided to help you manage your medical condition and reduce your risk of recurrent
strokes. Below is some important information found in your Stroke/TIA Education Folder:
Personal Modifiable Risk Factors for Stroke
 High blood pressure
 Overweight (BMI over 25)
 Smoking (If you smoke, quit. Avoid second hand smoke)
 Excessive alcohol intake (no more than one alcoholic drink per day)
 Atrial fibrillation
 High cholesterol
 Diabetes not well controlled
 Physical inactivity
 Carotid artery disease (clogged arteries that block blood flow to your brain)
 Peripheral artery disease
 Diet high in fat, cholesterol and salt
Medication
 The importance of taking your medication to control your risk factors and prevent a stroke
 Medication may need to be adjusted after you go home. Don’t stop your medications without speaking
to your physician first.
away.
Stroke / TIA Signs and Symptoms
 Sudden numbness or weakness of your face, arm or leg
 Sudden confusion, trouble speaking or understand speech
 Sudden trouble seeing in one or both eyes
 Sudden trouble walking, dizziness, loss of balance or coordination
 Sudden severe headache with no known cause
Not all the above signs occur with every stroke. Don’t ignore the signs of stroke even if they go
What time did the symptoms start? You will be asked this important question later.
How To Activate Emergency Medical System (EMS) for Stroke
 Don’t Drive, Don’t Delay, Dial 9-1-1 – Stroke is an Emergency
Need For Follow-up After Discharge
 It is important to receive regular medical care after you leave the hospital.
 Yes I received: the HOPE Stroke Recovery Guide, Stroke Reducing Risk and Recognizing Symptoms
Brochure, Explaining Stroke Brochure, stroke refrigerator magnet, pocket medication card
 No I decline these educational materials. Reason: _______________________________________________
Signature of Patient or Responsible Party
Date
Time (AM/PM)
Date
Time (AM/PM)
Stroke/TIA Education Materials Folder provided by:
Signature of Nurse
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Take Control of Your Health Record
Commit to Control Your Risk of Recurrent Stroke
Admission
Risk Factors
Please check
() your risk
factors below
Discharge
Action Plan / Goal
Risk factors ()
identified during
your hospitalization
Please write how you intend to control your risk factors.
You may ask your nurse or physician to help with this.
High blood pressure (140/90 or above)
*Leading cause of stroke
Currently smoke or quit less than 1 year
ago or exposure to second hand smoke
Unhealthy diet (high fat diet or don’t get
5 serving of fruit/vegetable per day)
Overweight (BMI over 25)
More than 1 alcoholic drink per day
Lack of daily exercise or moderateintensity physical activity for 30 minutes
High cholesterol (Total cholesterol over
200 and/or LDL over 100)
Thick waist (over 35.2 inches) and/or
High triglycerides (blood fat level)
Use of illegal drugs such as cocaine
Carotid Artery Stenosis (clogged artery
that supplies blood to the brain)
Atrial fibrillation
Diabetes
(hemoglobin A1C is 7 or higher)
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