Abstract T P127: AHA Guidelines NUrse Practitioner Cardiovascular Risk Education Program Delivered in Outpatient Stroke Rehabilitation Program Leads to Increased Independence with Medications, Self Blood Pressure Monitoring, Improved BLood Pressures, and Rehabilitaion Outcomes

Abstract

Background: Patients beginning an outpatient rehabilitation program often do not understand medications, good blood pressure (BP) control, and monitoring and recording of BPs Methods: An educational curriculum based on AHA guidelines and AHA Life’s Simple 7’s program was designed to improve patient understanding of medications, cardiovascular risk factors, and BP monitoring. Results: 51 consecutive patients, (27 men, 24 women, ages 41-90) with admit NIHSS 0-16 treated from 12/2011 to 7/2013 had an average of 9.6(0-21) NP visits with calls to MD about BP meds in 16%. On rehab admit, 6 patient/caregivers reported AHA recommendations for normal BP, and 7 patients/caregivers checked and recorded BPs. After NP sessions, 71%(36/51) patients checked and recorded BPs independently, 29% with assist. 46 patients received an average of 16.5 PT sessions, with BPs taken pre, during, and after exercise. Among 647 pre-exercise BPs, 37% were in AHA normal range(<120/80). 32% in mild (121-139/81-90), 28 % moderate (140-159/91-99), and 6% severe (>160/100). BPs measured during the first 75% of PT sessions were compared to BPs during the last 25%. 63% of patients had fewer moderate-severe range BPs and more normal-mild range. 14% had no change in mild-normal range BPs. 20% had some worsening of BP control. On admission, 6/51 (12%) patients could describe the name, purpose, dosage, schedule of all their medications, 16(31%) could describe partially, and 29(57%) gave no information about meds; 76%(16 aphasic) relied on caregivers for medication administration. After NP education, 31% of dependent patients became independent with med administration; 47% (6 aphasic) administered meds independently. 27(53%) (11 aphasic) remained dependant on caregivers. SIS Stroke Recovery Scale Domain scores increased an average of 41%(-50 to 167%) with 23/24 reporting improvement. 6” walk scores improved an average of 55%. Conclusions: Community dwelling stroke patients often cannot translate previously provided medication, CV risk factor, BP instructions into practical use. Patients receiving NP education as part of an outpatient rehab program showed improved independence with medication administration, blood pressure self monitoring, blood pressure control and rehab outcomes.