Stroke Education Program Research Articles

34 A Review of the Implementation of a Stroke Education Programme in a Dublin Teaching Hospital in 2018

Abstract Background Aim: To commence Stroke education in a specific Dublin Hospital to improve the assessment of management of Stroke patients. Methods Seven 1 day study days were organised in 2018. These study days were multidisciplinary team (MDT) led with theory in the morning session delivered by the Stroke Clinical Nurse Specialist (CNS) followed by MDT led workshops in the afternoon. Stroke education was delivered to Emergency Department (ED) doctors on each rotation. Whiteboard education sessions were carried out for nurses on Medicine for the Elderly Ward/Stroke Unit. Results A total of 103 health professionals were trained over the 7 study days. Stroke Study Day attendances consisted of 69 RGN/CNMs 26 student nurses (21 intern nurses who are now staff nurses working in the hospital), 2 Allied Health Professionals, 1 CNS and 5 from Practice development. 32 ED doctors were trained over 3 separate induction days. Weekly scenario based sessions with nurses on the Stroke Ward. Conclusion Staff applying the learned knowledge and competencies to Stroke patients has significantly improved following the commencement of the education. 100% of staff who attended the Stroke study day stated that the training improved their knowledge and skills. 100% of staff would recommend the Stroke Study Day to other colleagues. We aim to continue the study days and whiteboard sessions with health professionals in all wards in 2019.

A Pharmacist-Led Stroke Education and Screening Program for Community-Dwelling Older Adults

OBJECTIVES: To deliver a pharmacist-led education and screening for community-dwelling residents, assess the effect of this initiative on knowledge of stroke risk factors and warning signs, and evaluate the stroke-knowledge and risk-assessment questionnaire as a tool to identify stroke-related health status and identify need(s) for specific clinical intervention(s) to decrease risk.<br/> DESIGN: The 70-minute-long event comprised: brief introduction/informed consent, baseline assessment of stroke knowledge, completion of study questionnaire, single blood pressure and heart rate readings, presentation, question-and-answer session, postsurvey questionnaire items.<br/> SETTING: Four faith-based institutions in the Midwest.<br/> PARTICIPANTS: Independent community-dwelling adults 18 years of age and older (N = 97), 89.7% 60 years of age and older.<br/> INTERVENTIONS: Thirty-minute presentation followed by question-and-answer session on ischemic stroke. Screening for primary and secondary stroke-prevention status using study questionnaire and vital signs.<br/> MAIN OUTCOME MEASURE(S): Stroke knowledge regarding modifiable stroke-risk factors and acute stroke-warning signs, individual primary/secondary stroke-prevention status.<br/> RESULTS: Postintervention, mean number of modifiable stroke risk factors (2.6 ± 0.8) and warning signs (2.6 ± 0.8) named improved from preintervention (P < 0.001) including for most subgroups (i.e., self-reported hypertension, atrial fibrillation [AF], or high number of personal risk factors). Needs for improved primary/secondary prevention were identified for blood-measure control and antilipidemic therapy. No disparity was observed regarding thrombotic therapy in participants with AF.<br/> CONCLUSION: The program was resource-efficient, involved student pharmacists, improved immediate stroke-related knowledge of participants including those with increased risk(s) of stroke, and demonstrated value for evaluating stroke-related health status and identifying need for primary and secondary stroke prevention.

A Pharmacist-Led Stroke Education and Screening Program for Community-Dwelling Older Adults.

OBJECTIVES: To deliver a pharmacist-led education and screening for community-dwelling residents, assess the effect of this initiative on knowledge of stroke risk factors and warning signs, and evaluate the stroke-knowledge and risk-assessment questionnaire as a tool to identify stroke-related health status and identify need(s) for specific clinical intervention(s) to decrease risk.<br/> DESIGN: The 70-minute-long event comprised: brief introduction/informed consent, baseline assessment of stroke knowledge, completion of study questionnaire, single blood pressure and heart rate readings, presentation, question-and-answer session, postsurvey questionnaire items.<br/> SETTING: Four faith-based institutions in the Midwest.<br/> PARTICIPANTS: Independent community-dwelling adults 18 years of age and older (N = 97), 89.7% 60 years of age and older.<br/> INTERVENTIONS: Thirty-minute presentation followed by question-and-answer session on ischemic stroke. Screening for primary and secondary stroke-prevention status using study questionnaire and vital signs.<br/> MAIN OUTCOME MEASURE(S): Stroke knowledge regarding modifiable stroke-risk factors and acute stroke-warning signs, individual primary/secondary stroke-prevention status.<br/> RESULTS: Postintervention, mean number of modifiable stroke risk factors (2.6 ± 0.8) and warning signs (2.6 ± 0.8) named improved from preintervention (P < 0.001) including for most subgroups (i.e., self-reported hypertension, atrial fibrillation [AF], or high number of personal risk factors). Needs for improved primary/secondary prevention were identified for blood-measure control and antilipidemic therapy. No disparity was observed regarding thrombotic therapy in participants with AF.<br/> CONCLUSION: The program was resource-efficient, involved student pharmacists, improved immediate stroke-related knowledge of participants including those with increased risk(s) of stroke, and demonstrated value for evaluating stroke-related health status and identifying need for primary and secondary stroke prevention.

A Pilot Primary Stroke Prevention Program for Elderly Korean Americans.

Stroke is a significant health issue with devastating consequences among older adults in the United States. However, it can be prevented by improving stroke knowledge and managing risk factors. Many stroke education programs have been shown to be effective. Unfortunately, a minority of older adults, such as older Korean Americans, have not benefited from the programs because of language barriers. The purpose of this study was to examine the feasibility and preliminary impact of a primary stroke prevention program on stroke knowledge, healthy eating, and physical activity behaviors among Korean Americans. A randomized controlled pilot trial was conducted. A total of 73 persons were randomly assigned to either an intervention group (n = 37) or a control group (n = 36). The intervention program included in-person lectures and discussions. Sociodemographic data were analyzed using descriptive statistics. Analyses of covariance and logistic regression analysis were used to evaluate the effects of the intervention program. The mean age of participants was 71.49 ± 6.25 years, and most participants were female (74.0%) and married (65.8%). Upon intervention completion, the intervention group showed greater improvements than the control group in stroke knowledge and intake of sodium and total fats (F = 11.89, P = .001, ηp = 0.151; F = 4.04, P = .048, ηp = 0.057; and F = 4.51, P = .037,= ηp = 0.062, respectively). Step counts showed marginal effects (F = 3.27, P = .075, ηp = 0.049). This study demonstrated feasibility and effectiveness of the program to improve stroke knowledge and healthy behaviors in elderly Korean Americans.

A Stroke Reduction Health Plan for Older Adults in Rural Sussex County, Delaware.

Stroke is a leading cause of death and disability among adults age 65 and over in the United States. Modifiable risk factors for stroke include: obesity, poor nutrition, and lack of exercise. Sussex County, Delaware has the highest stroke rate among older adults in the state. Twenty-five percent of the population in Sussex County are 65 and over and about 70% of adults are overweight or obese. Consistent with the social ecological framework, the Stroke Population Risk Tool may be used at the individual level to identify those at an increased risk for stroke and to create individualized stroke specific education. At the community level, local nutrition, fitness, and senior services may be utilized - with older adults at the highest risk profile participating in a 12 week stroke education program focused on risk reduction behaviors, nutrition and exercise classes. At the policy level, the Walkability Assessment Tool may be utilized to encourage local municipalities to identify areas of the county which lack safe spaces to be physically active and to develop a plan to create a more exercise conducive environment. Taken together, the proposal discusses an implementable plan that may, in the long-term, effectively reduce the stroke rates of older adults in Sussex County and allow for the early identification of those at the greatest risk for stroke.

Awareness of stroke and assessment of knowledge of risk factors among stroke survivors in a tertiary care level hospital

Stroke is one of the leading causes of the death worldwide. Those who survive suffer with disability affecting their quality of life. Knowledge of stroke risk factors and awareness of stroke symptoms would reduce the incidence of stroke for the first time or recurrent. Also timely management would remains instrumental in reducing morbidity and mortality from stroke. The aim of the study was to examine knowledge of stroke, risk factors and its determinants among stroke survivors. An ongoing cross-sectional study in PMR department. Consenting stroke survivors attending the OPD and satisfying the inclusion criteria were enrolled for the study. Subjects were interviewed through a structured proforma, which included questions to assess their knowledge regarding stroke and risk factors A total of 100 subjects enrolled for the study. Mean age of subjects was 55.6 ± 6.8 years, M:F ratio was 7:1 & mean duration of stroke was 18.10 ± 12.2 months. Only 12% reported to specialized care within the window period. Almost 80% were unable to name a warning sign of stroke. Hypertension (80%), diabetes mellitus (42%), and smoking (23%) were identified as major risk factors. The knowledge of the risk factors was also very low and varies among the subjects depending on age and level of education. Forty-three percent could not name a single risk factor. It was also observed that management of risk factors were not appropriate in 55% of stroke survivors despite treatment either due to non adherence to the medication, improper follow-up, diet, lifestyle changes and education. Knowledge about stroke and risk factors were relatively poor. Large gaps in knowledge thereby place patients at high risk for stroke. Our finding highlights the need to develop stroke-education programs for stroke survivors as well for those high risk for stroke.

Strategy for cutting the arrival times to stroke centers: Stroke education programs for the youth

Strategy for cutting the arrival times to stroke centers: Stroke education programs for the youth

Effects of a school-based stroke education program on stroke-related knowledge and behaviour modification―school class based intervention study for elementary school students and parental guardians in a Japanese rural area

ObjectivesThis study aimed to determine the effect of a stroke education programme on elementary school students and their parental guardians in a rural area in Japan that has high stroke...

Stroke awareness in Korean high school students.

Public awareness is essential for the early diagnosis, treatment, and prevention of stroke. In particular, young adults represent an important avenue for increasing awareness and precluding the adoption of unhealthy, risk-increasing behaviors. This study was the first to investigate the basic knowledge of Korean adolescents about stroke and evaluate the improvement of this knowledge after an educational lecture. In total, 1269 high school students were instructed on the risk factors, symptoms, diagnosis, and management of stroke. Knowledge was evaluated before education (Pre-E), immediately after the lecture (Post-E1), and during a 2-week follow-up (Post-E2), using a questionnaire. Overall, we found that students' knowledge increased after the educational session. On the questionnaire section pertaining to stroke risk factors, out of nine possible points, the mean scores were 3.97, 5.28, and 5.10, on the Pre-E, Post-E1, and Post-E2 tests, respectively, indicating a significant improvement (p<0.001). Additionally, students who reported that they paid attention during the lecture performed better, and scored 4.29, 6.32, and 6.40, on the Pre-E, Post-E1, and Post-E2 tests, respectively, again indicating a significant improvement (p<0.001). Our findings indicate that incorporating a stroke education program into school curriculums will enhance the knowledge of Korean adolescents. Implementing this type of program is critical as it may reduce behavior associated with increased stroke risk, and more effort is needed to develop educational methods for engaging students and increasing their concentration during these programs.

Abstract TP278: Positive Impact of a Stroke Bundle Program

Introduction: There are limited comparative data on the impact of a stroke bundle program on patient outcomes. We aimed to assess the magnitude of change that could occur during transitions of care process by implementation of a stroke bundle program. Methods: Six skilled nursing facilities (SNF) participated with a Joint Commission certified Comprehensive Stroke Center to implement a Bundled Payment Care Initiative (BPCI) program. The stroke leadership developed a charter and additional support teams (care coordination and SNF). Three smart goals were identified and reflected organizational strategic goals: reduction of the number of stroke patients that are admitted to a SNF by 5% (baseline 27.9%); reduction of preferred provider SNF days for stroke patients by 10% (baseline 35.5%) and reduction of hospital readmissions for stroke by 5% (baseline 31.5%). A strong infrastructure supported the care coordination teams including the hiring of a full time stroke nurse navigator. The kick off for the program was October 1, 2015. Several strategic and operational initiatives were developed and successfully implemented at SNFs: utilization of stroke clinical practice guidelines: stroke education programs; stroke summit for all SNF administrators, physicians and staff; bi-monthly, face to face/conference call meetings with SNF administrators and bundle team leadership; case reviews between caregivers at acute setting and SNF; SharePoint site to enhance communication; stroke nurse navigator interaction with patients, families, SNF staff, 90 day follow up and readmission case reviews. Results: Smart goal achievement over a 6 month period demonstrated: reduction of the number of stroke patients that were admitted to SNF by .4% (21.9%); reduction of preferred provider SNF days for stroke patients by 16% (16%) and reduction of hospital readmissions for stroke by 7% (23.3%). Comparison of hospital length of stay variance between bundle (3.78) and non-bundle patients (5.08) patients was 1.3%. Conclusions: A stroke bundle program impacts positively on transitions of care at preferred provider SNF facilities. Standardization of care and a unified care team attributes to stroke patients returning to their life at home in a much more efficient and timely manner.

Abstract WP373: Emergency Medical Service Stroke Education in a Rural Community: Need for Improvement

According to The Journal of Emergency Medical Services (EMS) the goal of stroke care is to minimize brain injury and maximize recovery. The stroke chain of survival links actions taken by patients, family, EMS and healthcare providers. Recent innovations in stroke treatment require accurate identification and appropriate triage to the appropriate treatment facility. Evidence in the literature demonstrates variability with EMS correct identification of stroke patients between 30% and 80%. Our 164 bed primary stroke center in rural Pennsylvania has been active in providing stroke education on an annual basis to emergency medical services within a two county radius. As part of our ongoing process improvement we wanted to evaluate the emergency medical technicians and paramedics knowledge of stroke signs and symptoms, their understanding of the evaluation, treatment and triage of stroke patients. A standard questionnaire with 14 variables was developed using the American Heart and Stroke Association prehospital guidelines. The questionnaire included 16 stroke and non stroke symptoms, identifying transport to primary verses comprehensive stroke centers and initial evaluation. A sample population of 90 emergency medical service staff were asked to complete the questionnaire with 28 (31%) responses received. All participants indicated they were confident to recognize stroke signs and symptoms but 6 of the non stroke items were chosen as stroke symptoms. All participants indicated they were confident in the initial evaluation of a stroke patient but 14 (50%) appropriately identified airway, breathing, circulation as the first evaluation. Evaluating triage knowledge, 26 (93%) stated confidence in decision to transport to a primary stroke center and 22 (79%) to a comprehensive stroke center, however, appropriate decision to transport to a primary stroke center was identified correctly by 46% a comprehensive stroke center 66%. In conclusion, results from this study suggest that in this rural setting, barriers exist in prehospital recognition and evaluation of the stroke patient for which proper education may be remediable. Our goal is to use this information to revise our current EMS stroke education program and enhance prehospital assessment and triage.

Can Children Reduce Delayed Hospital Arrival for Ischemic Stroke?: A Systematic Review of School-Based Stroke Education.

Delayed hospital arrival after onset of ischemic stroke reduces the number of patients eligible for tissue plasminogen activator, which must be given soon after stroke onset. There are conflicting results about the impact of mass media stroke education on timing of hospital arrival and tissue plasminogen activator administration rates. School-based programs are a new way to communicate stroke information. A search of MEDLINE, CINAHL, PsycINFO, and ERIC databases from 1995 to 2014 identified school-based stroke education interventions. Twelve studies involving 3,312 children and 612 parents met criteria for review. School-based stroke education interventions were effective to improve knowledge of stroke symptoms among children in kindergarten through junior high. Improvement for stroke risk factors was less robust. Interventions were effective regardless of format, length, or who delivered the information. Despite low parental response rates in some studies, there was evidence that children transmitted stroke information to parents. School-based stroke education programs appear effective to improve knowledge of stroke symptoms. Research is needed to determine if children who participate are able to recognize stroke and respond appropriately by calling 911 in the real world. More study is needed about transfer of stroke knowledge from child to parent. Strategies to improve parent participation are needed.

Abstract WP327: Implementation of a Pharmacist Driven Comprehensive Stroke Education Program

Background: Stroke education (SE) is an important quality measure that has been shown to be inconsistently provided and ineffectively delivered. In response we have developed a pharmacist driven stroke education program (SEP) for patients admitted with stroke/TIA. Here, we describe the development, implementation, and encounters from this initiative. Methods: A stroke service team (SST) consisting of a board-certified cerebrovascular physician, cerebrovascular fellows, and a clinical pharmacist specialist (CPS) was established at the VA Greater Los Angeles Healthcare System. The CPS is alerted when any stroke/TIA patients are admitted and follows the patient until time of transfer/discharge. At that time, most diagnostic studies are complete and a likely stroke etiology has been determined, allowing for the development of a patient centered comprehensive stroke care and prevention plan based on individualized stroke risk factor analyses with input from interdisciplinary fields including the SST, rehabilitation specialists, and speech therapists. SE is provided at the time of discharge and addresses risk factors for stroke, stroke warning signs, activation of emergency medical services, need for follow-up after discharge and medications prescribed. The CPS also reviews stroke location, nature and quality of the stroke, and relays the initial patient centered comprehensive care plan to the patient in patient-level language. Visual aids assist in educating patients and a personalized education sheet is provided. The CPS is also responsible for documentation of SE for future evaluation of process measures. Results: Consistent implementation of the pharmacist driven comprehensive stroke education program (SEP) began in July 2013. To date, there have been 172 SE encounters documented. Quality improvement audits indicate close to 100% of all patients admitted for stroke receive SE. Conclusions: Here we show the successful implementation of a pharmacist driven comprehensive SEP designed to improve patient satisfaction/knowledge and improve hospital adherence to stroke quality measures. As pharmacists are trained to communicate with medical personnel and patients, they may be the ideal candidate to provide comprehensive and quality SE.

Abstract NS5: Improvement of Follow-up Rate After Discharge of Acute Ischemic Stroke Patients by the Man-to-man Education for Stroke During Admission

Background: We have executed a man-to-man stroke education program for acute ischemic stroke patients during admission since 2012. The contents of the man-to-man stroke education includes warning signs of stroke, guidance for prompt actions after symptom onset, drug information, and exercise and nutrition behavior after discharge. We evaluated whether the man-to-man education given during admission is effective to improve follow-up rates after discharge for acute ischemic stroke patients. Methods: We compared clinical data including modified Rankin Scale (mRS) at discharge and length of stay and follow-up data after discharge of 697 acute ischemic stroke patients (Male:Female=283:414, mean age±SD, 69.0±12.1 years) admitted in 2013, who received the man-to-man education during admission, with the data of 602 patients (M:F=254:348, 67.1±12.2 years) admitted in 2008, who did not receive the active education during admission. To evaluate follow-up rates, we first checked the follow-up status of all included patients within 1, 4, 8, 12, 16 months after discharge. Then, follow-up rates at each time point were calculated as the ratio of the number of patients followed at the point to the all patients discharged in 2008 or 2013. Differences of the follow-up rates between 2008 and 2013 were compared at individual follow-up time points using one-sided x2-test. Results: Even though the favorable outcome defined as 0-3 of mRS at discharge was similar between 2008 and 2013 (2008 vs. 2013, 88.3 vs. 87.4%, p=0.342), length of admission was significantly shorter in 2013 than 2008 (2008 vs. 2013, 10.2 vs. 6.6 days, p&lt;0.001). On follow-up rates evaluations, follow-up at 1 month was significantly higher in 2013 (89.8%) than 2008 patients (83.7%) (p=0.001). The follow-up rates subsequently decreased at 4months (2008 vs. 2013, 77.3 vs. 81.5%, p=0.040), 8 months (70.1 vs. 74.3%, p=0.051), 12 months (63.1vs. 67.6%, p=0.052), and 16 months (57.6 vs. 63.0%, p=0.028). However, the follow-up rates of 2013 patients was consistently higher than 2008 ones. Conclusion: The present data suggested that active education program for acute ischemic stroke patients could improve to follow-up rates of the patients after discharge.

Translation and validation of the Malay version of the Stroke Knowledge Test

BackgroundTo date, there is a lack of published studies on assessment tools to evaluate the effectiveness of stroke education programs. MethodsThis study developed and validated the Malay language version of the Stroke Knowledge Test research instrument. This study involved translation, validity, and reliability phases. The instrument underwent backward and forward translation of the English version into the Malay language. Nine experts reviewed the content for consistency, clarity, difficulty, and suitability for inclusion. Perceived usefulness and utilization were obtained from experts’ opinions. Later, face validity assessment was conducted with 10 stroke patients to determine appropriateness of sentences and grammar used. A pilot study was conducted with 41 stroke patients to determine the item analysis and reliability of the translated instrument using the Kuder Richardson 20 or Cronbach’s alpha. ResultsThe final Malay version Stroke Knowledge Test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Psychometric investigations suggest that Malay version Stroke Knowledge Test had moderate reliability with Kuder Richardson 20 or Cronbach’s alpha of 0.58. Improvement is required for Stroke Knowledge Test items with unacceptable difficulty indices. Overall, the average rating of perceived usefulness and perceived utility of the instruments were both 72.7%, suggesting that reviewers were likely to use the instruments in their facilities. ConclusionsMalay version Stroke Knowledge Test was a valid and reliable tool to assess educational needs and to evaluate stroke knowledge among participants of group-based stroke education programs in Malaysia.

Abstract T MP38: Impact of Community Stroke Education and Comprehensive Stroke Care in South Texas

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the impact of our coordinated stroke education programs and establishment of comprehensive stroke care in South Texas border town on the utilization of and outcomes associated with thrombolytic use. Previous studies have identified prominent disparities in health care delivery in these regions of the United States METHODS: We identified all patients who had a discharge diagnosis of ischemic stroke from January 2010 till July 2014 at one Primary Stroke center in South Texas using ICD codes of 434.91, 433.31, 434.01 and 434.11. We studied the trend of growth in stroke care delivery over the last 5 years in the subset of patients who received intravenous recombinant tissue plasminogen activator (IV rt-PA) and those who were treated with endovascular interventions. Starting in July 2012, a public stroke education plan was implemented over an 18 month period. The plan included an annual stroke symposium, quarterly education with early response team members, quarterly lectures to surrounding emergency rooms, public radio and television advertisements in English and Spanish stressing the AHA F.A.S.T. acronym, billboards, and grand rounds with internal medicine, family practice and emergency room physicians at all of our referral hospitals. RESULTS: Total number of ischemic stroke patients per year grew linearly from 343 in 2010 to over 550, as projected, in 2014. Proportion of patients treated with IV rt-PA increased from 3.2% in 2010 to 13.8% in 2014. The significant increase in thrombolytic use was due to a greater proportion of patients arriving to the emergency room within 4.5 hours , with no difference in rates of post thrombolytic intracerebral hemorrhages . A total of 14.5% of acute ischemic stroke patients received endovascular treatment in 2014 compared with 6.3 % in 2012 when endovascular service was established. The proportion of patients who had either IV or endovascular treatment was 25.7% in 2014 compared with only 3.2% in 2010. CONCLUSIONS: Intensified public stroke education and establishment of comprehensive stroke care significantly increased intravenous thrombolytic and endovascular treatment utilization in a South Texas border town over four fold within 18 months.

Abstract T P144: Rural Stroke System Development and Patterns of Arrival

Introduction: The Iowa Stroke Registry (ISR) is one of the Paul Coverdell Registries of the Centers for Disease Control. Its goal is to assess the performance of the Iowa Stroke System and to conduct system improvement to improve stroke care and outcomes. One of the major challenges in rural state is acute intervention in a geographically dispersed population and transport to definitive care. Methods: The Iowa Stroke Registry was established in 2007 with data collection from 32 comprehensive, primary and stroke capable hospitals in Iowa beginning in 2009. To date over 10,000 patients have been enrolled. Arrival to the ISR was characterized as via EMS, private vehicle or transfer from another facility. Factors related to stroke symptoms and presentation and time to arrival from last known well were examined by arrival mode. Categorical analysis was done using a Chi-Square Test with an alpha of 0.05. Results: To date 39% of patients with stroke came directly by ambulance, 35% by private vehicle and 25% transferred from local hospitals. Of EMS transported patients were 94% were admitted through the ER; 13% of private vehicle and 32% of transfer patients were directly admitted to inpatient beds. Admission symptoms were similar regardless of transport mode with 64% of patients with weakness, 10% speech difficulties, 3% vision abnormalities and 28% with aphasia. Ambulation with assistance or unable to ambulate was highest in private vehicle patients (8.6%)(p&lt;.05). Transfer (median=347 minutes) and private vehicle (median=408) were significantly longer than EMS arrivals (median=222). As the system developed, the percentage of transfer patients significantly increased over time. Conclusions: With nearly one-third of patients still arriving by private vehicle there is a need for further public education. Increase in transfers demonstrate the effect of stroke system development. These data from the ISR provide information for a wide-ranging stroke education program by the Coverdell Registry and Stroke Task Force committees and stakeholders in Iowa.

Problems and limitations in thrombolysis of acute stroke patients at a tertiary care center.

Aim:(1) To evaluate the number of patients thrombolysed within 1 h of arrival to emergency room (ER) (2) To identify reasons for delay in thrombolysis of acute stroke patients.Materials and Methods:All patients admitted to ER with symptoms suggestive of stroke from January 2011 to November 2013 were studied. Retrospective data were collected to evaluate ER to needle (door to needle time [DTNt]) time and reasons for delay in thrombolysis. The parameters studied (1) onset of symptoms to ER time, (2) ER to imaging time (door to imaging time [DTIt]), (4) ER to needle time (door to needle) and (5) contraindications for thrombolysis.Results:A total of 695 patients with suspected stroke were admitted during study period. 547 (78%) patients were out of window period. 148 patients (21%, M = 104, F = 44) arrived within window period (<4.5 h.). 104 (70.27%) were contraindicated for thrombolysis. Majority were intracerebral bleeds. 44 (29.7%) were eligible for thrombolysis. 7 (15.9%) were thrombolysed within 1 h. The mean time for arrival of patients from onset of symptoms to hospital (symptom to door) 83 min (median - 47). The mean door to neuro-physician time (DTPt) was 32 min (median - 15 min). The mean DTIt was 58 min (median - 50 min). The mean DTNt 104 (median - 100 min).Conclusion:Reasons for delay in thrombolysis are: Absence of stroke education program for common people. Lack of priority for triage and imaging for stroke patients.

Abstract NS7: Measurement of Acute Stroke Nursing Knowledge: Opportunities for Improvement in Stroke Nursing Education

Background: Nurses caring for acute stroke patients require significant knowledge and skills to deliver expert evidence-based care. However, stroke nurse knowledge has not been captured with standardized methods until recently. We sought to measure knowledge in nurses participating in the NET SMART Junior program. Methods: NET SMART Junior is a novel on-line acute stroke learning system with more than 2500 users worldwide. The program provides both didactic and optional clinical skills exercises, with topics covering all aspects of prehospital and acute hospital management. We analyzed an international sample of test scores from NET SMART Junior, among users that completed the clinical competency portion of the program. Data were auto-assembled in Moodle and analyzed in SPSS. Results: 216 scores were analyzed; the sample consisted of 8 MSN nurses and 208 (96%) basic nurses. Overall program entry knowledge scores were 37%+/-14%, median 39% correct; significantly lower scores of 36%+/-14%, median 38% correct were found among staff nurses, as compared to 50%+/-15%, median 49% correct (mean diff 13.8; 95% CI 3.8-23.8; p=0.007) among MSN nurses. The lowest knowledge scores were found for reperfusion therapy, neurocritical care and complication avoidance (Table). No differences were found in users indicating completion of unit-based stroke educational programs or other for-profit on-line educational programs. Post-test scores were similar between groups with MSN nurses scoring 94%+/-5% (median 90%) and staff nurses scoring 95%+/-5% (median 100%; p=ns) on completed modules. Among 29 (13%) users indicating completion of a stroke certification examination (SCRN or NVRN), 100% pass rates were reported. Conclusions: Staff nurses have a variety of learning needs tied to acute stroke management. Comprehensive acute stroke education programs should include more expert level content and be supported by clinical application methods to ensure content mastery.

Stroke Education Program of Act FAST for Junior High School Students and Their Parents

We produced a stroke education program using the FAST (facial droop, arm weakness, speech disturbance, time to call an ambulance) mnemonic. The aim of this study is to examine efficacy of our education program for junior high school students and their parents. One hundred ninety students of 3 junior high schools (aged 12-13years) and their parents were enrolled. Students received a 45-minute lesson of stroke enlightenment using the FAST mnemonic. Enlightenment items, such as a magnet poster, were distributed. Parents were educated indirectly from their child. Surveys of stroke knowledge were examined at baseline, immediately after the lesson, and at 3months after the lesson. For the students, correct answers at 3months were significantly higher than those at baseline in questions of facial palsy (98% versus 33%), speech disturbance (98% versus 54%), numbness on one side (64% versus 42%), weakness on one side (80% versus 51%), calling an ambulance (88% versus 60%), alcohol drinking (85% versus 65%), smoking (70% versus 43%), dyslipidemia (58% versus 46%), hyperglycemia (59% versus 48%), and obesity (47% versus 23%). At 3months, the parents answered more correctly questions of facial palsy (93% versus 66%), calling an ambulance (95% versus 88%), and alcohol drinking (65% versus 51%) than at baseline. At 3 months, 96% of students and 78% of parents answered the FAST mnemonic correctly. Our stroke education program improved stroke knowledge, especially the FAST message, for junior high school students and their parents.