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CH149-Stroke Awareness, Prevention, and Care Policy

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Registration Number: {{org_field_registration_no}}

Stroke Awareness, Prevention, and Care Policy

1. Purpose

This policy ensures that all staff at {{org_field_name}} understand the importance of stroke awareness, are equipped to identify signs of a stroke, respond promptly and appropriately, and support individuals with stroke-related conditions. It sets out clear protocols for early identification, timely emergency response, prevention strategies, rehabilitation, and the delivery of person-centred post-stroke care. The policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, particularly Regulation 9 (Person-centred care), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding), and Regulation 17 (Good governance). It also aligns with the principles of the Care Act 2014, especially in promoting independence, well-being, and dignity.

2. Scope

This policy applies to all care and support staff, managers, health professionals, and visiting practitioners working under or in partnership with {{org_field_name}}. It includes staff involved in care planning, direct care delivery, risk assessments, and emergency response. It applies to both existing people we support living with the effects of stroke and individuals at increased risk due to medical history, lifestyle, or age. This policy ensures that stroke care is proactive, coordinated, and tailored to individual needs and preferences.

3. Related Policies

This policy must be read alongside:

4. Policy Details

4.1 Stroke Awareness and Staff Training

All staff must be trained in recognising the early warning signs of stroke using the FAST (Face, Arms, Speech, Time) approach. Training includes understanding different types of strokes (ischemic, haemorrhagic, and transient ischaemic attacks – TIAs) and their common symptoms. Staff receive refresher training annually and new staff receive this as part of their induction. Ongoing education includes how strokes affect cognition, mobility, speech, mood, and independence, and how to adjust support accordingly. Knowledge is assessed through competency checks and scenario-based reviews during supervisions.

4.2 Emergency Response Protocol

Where a stroke or transient ischaemic attack (TIA) is suspected, staff must treat the situation as a medical emergency and call 999 immediately for an ambulance. Staff must not delay calling 999 while seeking advice from a senior member of staff, the Registered Manager, a GP, NHS 111, family members or any other person.

Staff must use the FAST approach to identify the principal signs of stroke:

Staff must also recognise that stroke or TIA may present with other sudden neurological symptoms, including sudden weakness or numbness affecting one side of the body, sudden visual disturbance or loss of vision, sudden difficulty finding or understanding words, sudden confusion, dizziness, loss of balance or co-ordination, severe headache, nausea or vomiting, or sudden difficulty swallowing.

A person must still receive urgent emergency assessment where stroke or TIA symptoms improve or disappear. Staff must not cancel or downgrade an emergency response solely because the person’s symptoms have resolved. If symptoms suggestive of stroke or TIA have occurred within the previous 24 hours and emergency medical assessment has not already taken place, staff must seek urgent emergency assistance in accordance with current NHS advice.

When contacting the ambulance service, staff must provide all available relevant information, including:

Staff must follow the instructions provided by the 999 call handler and attending clinicians and must remain with and reassure the person while awaiting emergency assistance, unless doing so would place another person at immediate risk.

Staff must not independently diagnose the type of stroke, commence a new medicine, change a prescribed medicine, give medication specifically to treat a suspected stroke or TIA, or carry out a clinical intervention that is outside their role, competence or authorisation. Existing prescribed treatment must be managed in accordance with the person’s medication plan and any instructions received from an appropriately qualified healthcare professional.

The person’s current care records, medication information, known allergies, relevant risk assessments, emergency healthcare information and other necessary information must be made available to the ambulance crew promptly and must accompany the person where required to support safe transfer of care.

The senior member of staff on duty and the Registered Manager, {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}, must be informed as soon as practicable, but this must never delay the emergency response.

The person’s family, representative or relevant person must be informed where appropriate, taking account of the person’s wishes, consent, capacity, confidentiality requirements, any lawful authority held by another person and the immediate clinical circumstances.

Following the emergency, an accurate and contemporaneous record must be completed. This must include, where applicable:

Following the person’s return to the home or receipt of further clinical information, their care plan, risk assessments, medication records and relevant support plans must be reviewed without delay and updated where required.

4.3 Risk Assessment and Prevention Strategies

Stroke-related risks must be considered as part of each person’s initial assessment and thereafter whenever their health, treatment, mobility, communication, nutrition, hydration or other relevant circumstances change.

The assessment and care-planning process must be person-centred and proportionate to the person’s individual circumstances. Staff must identify, record and appropriately escalate known factors that may increase the person’s risk of stroke or further stroke, including where relevant:

Care staff must work within the limits of their role, training and competence. They must not diagnose medical conditions, independently determine a person’s clinical stroke-risk score, alter prescribed medication or make clinical treatment decisions unless they are appropriately qualified and authorised to do so.

Where staff identify a new risk factor, deterioration, abnormal observation, change in the person’s presentation or concern regarding prescribed treatment, this must be escalated promptly to an appropriate healthcare professional in accordance with the person’s care plan and the urgency of the situation.

Where blood pressure, pulse or other health observations form part of the person’s agreed care plan, they must only be undertaken by staff who have been trained and assessed as competent to carry out and record those observations. Results must be acted upon in accordance with the person’s agreed parameters, escalation plan and professional instructions.

Stroke-prevention support must reflect the person’s assessed needs, preferences, capacity and clinical advice and may include:

Any preventative intervention delivered by the service must be within the service’s scope of practice and the competence of the staff involved.

Identified stroke-related risks and the measures in place to mitigate them must be clearly recorded within the person’s care documentation. Risk assessments must be reviewed at planned intervals and without delay following any material change in the person’s health, needs, treatment or circumstances, a suspected TIA or stroke, hospital admission or discharge, medication change, fall or other relevant incident.

4.4 Person-Centred Post-Stroke Care and Rehabilitation

Following a stroke, care and support must be based on an assessment of the person’s current physical, psychological, cognitive, communication, nutritional, hydration, mobility and social needs. Care must be planned with the person and, where appropriate and lawful, with people acting on their behalf and relevant healthcare professionals.

The care plan must reflect the person’s individual goals, preferences, abilities and risks and must support independence wherever this can be achieved safely.

Post-stroke care may include:

Staff must only undertake rehabilitation exercises, therapeutic techniques or other interventions where these have been recommended or agreed by an appropriately qualified professional and staff have received sufficient information, instruction and, where required, competency assessment to carry them out safely.

Swallowing, Dysphagia, Nutrition and Aspiration Risk

People who have experienced a stroke may have difficulty swallowing and may therefore be at increased risk of choking, aspiration, dehydration and malnutrition.

Where swallowing difficulties are known or suspected, staff must:

Staff must not independently alter a prescribed or professionally recommended food texture or fluid consistency unless instructed by an appropriately qualified healthcare professional.

Where a person has capacity, their informed choices concerning eating and drinking must be respected after relevant risks and options have been explained. Where the person lacks capacity for the particular decision, any decision concerning eating, drinking or associated risk must be made in accordance with the Mental Capacity Act 2005 and properly recorded.

Communication and Cognitive Support

Where stroke has affected speech, language, cognition or understanding, staff must use the person’s assessed preferred methods of communication. This may include additional time, simple language, pictures, communication aids, writing, gestures or other reasonable adjustments recommended by speech and language therapy or other professionals.

Communication difficulties must not be assumed to mean that the person lacks mental capacity.

Emotional and Psychological Well-being

Staff must remain alert to changes in mood, emotional well-being or behaviour following stroke, including signs of anxiety, depression, distress, frustration or social withdrawal. Concerns must be recorded and referred or escalated to an appropriate healthcare professional where necessary.

All post-stroke care must protect the person’s dignity, privacy and autonomy and must be delivered in accordance with their individual needs and preferences and the requirements of Regulations 9, 10, 12 and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

4.5 Communication and Collaboration with Health Professionals

{{org_field_name}} will work collaboratively with relevant health and care professionals to ensure that people who have experienced a stroke, or who have identified stroke-related risks, receive safe and co-ordinated care.

Depending upon the person’s needs, this may include liaison with:

Professional recommendations that are relevant to the care delivered by {{org_field_name}} must be recorded in the person’s care documentation, communicated to relevant staff and implemented promptly within the service’s scope of responsibility.

Where staff are unclear about a professional recommendation, where instructions conflict, or where the service cannot safely implement a recommendation, clarification must be sought from the relevant healthcare professional without delay. Staff must not substitute their own clinical judgement for specialist instructions where doing so is outside their professional competence.

Any deterioration, new neurological symptoms, swallowing problems, recurrent falls, changes in mobility, medication concerns or other material changes in the person’s condition must be escalated to an appropriate healthcare professional according to the urgency of the situation. Suspected acute stroke or TIA must be managed in accordance with section 4.2 of this policy and must not be referred through a routine pathway.

Admission to Hospital, Discharge and Transfer of Care

When a person is transferred to hospital or another care setting, relevant and accurate information necessary for their safe care must accompany or be made available to the receiving service. This should include, where relevant:

When a person returns from hospital or another service, staff must obtain and review available discharge information and identify any changes to:

Relevant care plans, risk assessments and medication records must be updated promptly. Any discrepancy, unclear instruction or missing information that could affect safe care must be clarified with the relevant healthcare service or professional.

Information must be shared lawfully, securely and only to the extent necessary for the person’s care, in accordance with applicable data protection and confidentiality requirements and CH34 – Confidentiality and Data Protection (GDPR)-Service User Policy.

4.6 Supporting Family Involvement, Advocacy, Consent and Mental Capacity

People must be supported to participate as fully as possible in decisions about their stroke prevention, treatment, rehabilitation and ongoing care.

Care and treatment must only be provided with appropriate consent in accordance with Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Where the person has capacity to make the particular decision, their decision must be respected, including where their decision differs from the wishes of relatives or professionals, subject to the service’s continuing duty not to provide care or treatment that is unsafe or outside its lawful scope.

Information about proposed care, support or treatment must be given in a form that the person can understand. Staff must make reasonable adjustments and provide appropriate communication support where stroke has affected the person’s speech, language, vision, hearing, cognition or ability to communicate.

A person’s communication impairment, diagnosis, age, appearance, behaviour or need for support must not in itself be treated as evidence that the person lacks mental capacity.

Where there is reason to doubt whether a person can make a particular decision, mental capacity must be considered in accordance with the Mental Capacity Act 2005. Capacity is decision-specific and time-specific. Staff must:

Where the person lacks capacity to make the relevant decision, any act or decision made on their behalf must be in their best interests and must be the least restrictive option consistent with achieving the required purpose.

When deciding what is in the person’s best interests, appropriate consideration must be given to the person’s past and present wishes and feelings, beliefs and values and, where practicable and appropriate, the views of people who should be consulted under the Mental Capacity Act 2005.

Family members must be involved where the person wishes this, or where consultation is appropriate as part of a lawful best-interests process. A relative, including a spouse, partner, child or next of kin, does not automatically have legal authority to consent to care or treatment for an adult who lacks capacity.

Where another person holds valid legal authority relevant to the particular decision, including a health and welfare attorney appointed under a Lasting Power of Attorney or a deputy appointed by the Court of Protection, the service must establish and record the nature and scope of that authority and involve them accordingly.

Where the statutory criteria for an Independent Mental Capacity Advocate are met, arrangements must be made for an IMCA in accordance with the Mental Capacity Act 2005.

Any restriction or restraint associated with post-stroke care must be lawful, necessary and proportionate and must comply with the Mental Capacity Act 2005 and any other applicable legal safeguards.

Consent, mental-capacity assessments, best-interests decisions, consultation and the legal authority of representatives must be clearly documented in the person’s care records where relevant.

4.7 Equipment and Environmental Adaptations

Where necessary, the environment is adapted to support post-stroke mobility and safety. This may include grab rails, anti-slip mats, seating support, adapted utensils, and bed or bathroom aids. Any assistive technology is introduced with full risk assessment, consent, and staff training. Equipment is maintained and checked in accordance with Regulation 15 (Premises and Equipment) and our health and safety protocols.

4.8 Monitoring and Quality Assurance

The Registered Manager will maintain systems for monitoring the safety, quality and effectiveness of stroke-related care provided by {{org_field_name}}.

Care plans, relevant risk assessments, monitoring records and professional recommendations for people who have experienced a stroke or who have significant identified stroke-related risks must be reviewed at planned intervals and whenever there is a material change in their needs, health, treatment or circumstances.

Where the service’s established review schedule requires monthly review, that schedule will continue to apply. A planned monthly review must not delay an earlier review where:

Records relating to stroke care must be accurate, complete, legible, contemporaneous and maintained securely. Records must include relevant assessments, observations, decisions, professional advice, action taken and changes to care.

Audits must be used where appropriate to assess whether:

Any deficit identified through an audit, incident investigation, complaint, safeguarding concern, professional feedback or other quality-assurance process must be assessed, acted upon within a timescale proportionate to the risk and monitored until appropriate action has been completed.

Learning identified from stroke-related events must be shared with relevant staff and incorporated into training, supervision, risk management, care planning or organisational procedures where necessary.

Oversight of this process rests with the Registered Manager and, where appropriate, findings and significant concerns will be reported through the organisation’s governance arrangements to the Nominated Individual, {{org_field_nominated_individual_first_name}} {{org_field_nominated_individual_last_name}}.

4.9 Incident Reporting, Statutory Notifications and Duty of Candour

All suspected or confirmed stroke-related incidents occurring while a person is receiving care from {{org_field_name}} must be recorded and managed in accordance with the organisation’s incident-reporting procedures.

The fact that a person has experienced a stroke or transient ischaemic attack does not, by itself, mean that the event is automatically reportable to the Care Quality Commission. The Registered Manager must consider the circumstances and outcome of the event against the statutory notification requirements.

Where an event meets the criteria for notification under the Care Quality Commission (Registration) Regulations 2009, the registered person must ensure that the Care Quality Commission is notified without delay using the required notification process. This includes, where applicable, a qualifying serious injury or another specified incident occurring while a regulated activity is being provided or as a consequence of the manner in which the regulated activity was provided.

Where there is any uncertainty about whether the statutory notification criteria are met, the Registered Manager or other appropriately authorised senior person must review the circumstances promptly against the current CQC notification requirements.

The service must also consider whether a stroke-related incident constitutes a notifiable safety incident for the purposes of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Where the statutory duty of candour applies, {{org_field_name}} must comply with the requirements of Regulation 20, including:

The duty of candour process is separate from, and does not replace, any requirement to:

Where a stroke, deterioration or other adverse outcome may have been contributed to by an omission, delay, medication error, failure to recognise deterioration, failure to follow a swallowing or care plan, inadequate monitoring or another potential failure in care, the matter must be escalated to the Registered Manager without delay and investigated in accordance with the organisation’s governance, safeguarding and incident-management procedures.

All decisions concerning notification, duty of candour, investigation and resulting actions must be clearly documented.

5. Policy Review

This policy is reviewed annually, or sooner in response to changes in legislation, CQC guidance, or evidence from audits, incidents, or clinical practice developments.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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