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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Stroke Awareness, Prevention and Care Policy

1. Purpose

This policy sets out the arrangements adopted by {{org_field_name}} to promote stroke awareness and prevention, recognise signs and symptoms of stroke promptly, obtain emergency medical assistance without delay, and provide safe, person-centred care and support to individuals who have experienced a stroke.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016; the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended; the Social Services and Well-being (Wales) Act 2014; the Mental Capacity Act 2005, where applicable; and relevant statutory guidance issued by the Welsh Ministers and regulatory requirements applied by Care Inspectorate Wales.

Care and support relating to stroke must protect, promote and maintain the individual’s safety and well-being and must be provided in accordance with the individual’s assessed needs and personal plan. Relevant health assessments, professional advice, the individual’s views, wishes and feelings, identified risks and personal outcomes must be taken into account.

The purpose of this policy is to ensure that staff recognise possible signs and symptoms of stroke, obtain urgent medical assistance when stroke is suspected, and provide appropriate ongoing care and support within the limits of their role, competence and training. Following a stroke or any significant change in an individual’s needs, the individual’s provider assessment and personal plan must be reviewed and revised as necessary, and appropriate healthcare or specialist advice must be obtained.

2. Scope

This policy applies to all staff employed by {{org_field_name}}, including permanent, temporary, agency, and volunteer staff. It also applies to any individual residing in our care home who has experienced or is at risk of experiencing a stroke. The policy includes staff responsibilities, training expectations, early identification procedures, response mechanisms, rehabilitation support, care planning, and family engagement.

3. Related Policies

This policy should be read in conjunction with the following:

• CHW07 – Person-Centred Care Policy
• CHW08 – Dignity and Respect Policy
• CHW09 – Consent to Care Policy
• CHW11 – Safe Care and Treatment Policy
• CHW12 – Meeting Nutritional and Hydration Needs Policy
• CHW17 – Infection Prevention and Control Policy
• CHW18 – Risk Management and Assessment Policy
• CHW24 – Management of Accidents, Incidents and Near Misses Policy
• CHW27 – Staff Supervision, Training, and Development Policy
• CHW36 – Initial Assessment and Care Planning Policy
• CHW40 – Assisting with Personal Care Policy

4. Policy Statement and Implementation

4.1 Promoting Stroke Awareness Among Staff and Residents

{{org_field_name}} is committed to increasing awareness of stroke symptoms, risk factors and the potential short-term and long-term effects of stroke.

Staff who provide care and support must receive training appropriate to their role and to the needs of the individuals using the service. This will include training in recognising the signs and symptoms of stroke and understanding the need for immediate emergency action where a stroke is suspected.

Staff will be made aware of the FAST approach:

• Face – facial weakness or drooping;
• Arms – weakness or inability to raise one or both arms;
• Speech – slurred, confused or altered speech; and
• Time – the need to call 999 immediately where stroke is suspected.

Staff must also remain alert to other sudden neurological changes which may indicate stroke and must not rely exclusively on FAST where an individual presents with other acute symptoms.

Relevant stroke-awareness training will form part of the service’s training programme and will be reviewed in accordance with staff roles, assessed needs within the service, changes in guidance and identified learning requirements.

The Registered Manager will ensure that staff undertaking stroke-related care have the appropriate knowledge, skills and competence for the duties they perform.

Information about stroke recognition may also be made available to individuals, relatives and visitors in an accessible format where appropriate.

4.2 Stroke Risk Assessment and Prevention

As part of the provider assessment, admission process and ongoing review of the individual’s needs, {{org_field_name}} will consider known factors that may affect the individual’s risk of stroke, taking account of available care and support plans, health assessments, hospital discharge information, prescribed treatment, professional advice and the individual’s views, wishes and feelings.

Relevant factors may include, where identified by an appropriate healthcare professional:

• hypertension;
• atrial fibrillation or other relevant cardiovascular conditions;
• diabetes;
• previous stroke or transient ischaemic attack;
• smoking;
• alcohol consumption;
• nutrition and hydration;
• mobility and physical activity; and
• other relevant conditions or risk factors identified by healthcare professionals.

Staff must work within the limits of their role, training and competence. Clinical assessment, diagnosis or alteration of treatment must only be undertaken by an appropriately qualified healthcare professional.

Where a risk or healthcare need is identified, the individual’s personal plan must clearly set out:

• the care and support required;
• agreed monitoring arrangements;
• action staff must take if concerns arise; and
• any relevant professional instructions.

{{org_field_name}} will support individuals, where appropriate and in accordance with their wishes and personal plan, to reduce modifiable risk factors through measures such as:

• maintaining appropriate nutrition and hydration;
• supporting mobility and physical activity;
• supporting smoking cessation where requested;
• supporting healthy lifestyle choices; and
• facilitating access to GP or other healthcare services.

Blood pressure or other clinical observations will only be undertaken where this forms part of the individual’s assessed care and support needs, personal plan or professional instructions, and by staff who are trained and competent to undertake the activity.

Medicines must be supported and administered in accordance with the individual’s personal plan, current prescription, professional instructions and the service’s medicines policy.

Staff must not independently commence, discontinue or alter prescribed stroke-prevention medicines or other treatment.

4.3 Emergency Response to Suspected Stroke

Any suspected stroke must be treated as a medical emergency.

Staff must use their stroke-awareness training, including the FAST approach, to recognise possible signs and symptoms. Staff must also remain alert to other sudden neurological changes that may indicate stroke.

Where a stroke is suspected, staff must:

1. Call 999 immediately and state that a stroke is suspected. Calling 999 must not be delayed while waiting for a senior member of staff, the Registered Manager, GP, family member or representative.
2. Follow all instructions given by the emergency medical call handler and ambulance service.
3. Note, so far as this can be established without delaying emergency assistance:
   • the time the symptoms were first noticed;
   • when the individual was last known to be at their normal baseline, where this is known;
   • the symptoms observed; and
   • any relevant information requested by the ambulance service.
4. Stay with the individual, provide reassurance, maintain their safety and observe for changes while awaiting emergency assistance.
5. Do not give food, drink or oral medication where there is concern that swallowing may be impaired, unless specifically directed by an appropriately qualified healthcare professional or emergency service.
6. Make the individual’s current medicines information, relevant care records, emergency healthcare information and any advance care planning information available to attending emergency personnel, subject to applicable confidentiality requirements.
7. Inform the senior member of staff on duty and the Registered Manager as soon as practicable without delaying emergency treatment.
8. Inform the individual’s representative or family member in accordance with the individual’s wishes, consent, personal plan and any lawful authority to receive information.
9. Record the event, observations, actions taken, advice received and outcome in the individual’s records.
10. Complete any required accident or incident documentation in accordance with CHW24.
11. Consider whether the event meets any statutory notification or reporting requirement and ensure any required notification is made through the appropriate process.

Emergency stroke response will form part of relevant staff training and competency arrangements.

Staff must understand that prompt access to emergency medical assessment takes priority over internal reporting or administrative procedures.

4.4 Post-Stroke Care, Reassessment and Rehabilitation

Where an individual returns to {{org_field_name}} following a stroke, or where a stroke results in a significant change in an individual’s care and support needs, the individual’s needs must be reassessed promptly.

The service must obtain and consider relevant information from the hospital, GP, community health services and other professionals involved in the individual’s care.

This may include:

• hospital discharge information;
• current medicines information;
• rehabilitation recommendations;
• swallowing and nutrition guidance;
• mobility and moving and handling advice;
• communication recommendations;
• cognitive or psychological recommendations;
• continence-related recommendations;
• pressure care requirements; and
• follow-up appointments or referrals.

The individual’s provider assessment must be reviewed and revised as necessary.

Following the revised provider assessment, the individual’s personal plan and associated risk assessments must also be reviewed and revised as necessary so that staff have clear, current instructions for meeting the individual’s needs on a day-to-day basis.

The review and revision must involve the individual and, where applicable and appropriate, the placing authority and representative, in accordance with the individual’s wishes, rights and applicable legal requirements.

Depending upon the individual’s assessed needs, post-stroke care may include:

• support with mobility, transfers, positioning and rehabilitation exercises in accordance with professional advice;
• support with personal care while promoting independence and positive risk-taking where appropriate;
• prevention and management of risks associated with reduced mobility, including pressure damage, falls and contractures, where relevant;
• support with nutrition and hydration;
• implementation of any swallowing recommendations made by a speech and language therapist or other appropriately qualified healthcare professional;
• use of the prescribed texture of food or thickness of fluids where this has been professionally recommended;
• monitoring for coughing, choking, recurrent chest infection, changes in swallowing ability or other signs of deterioration and obtaining professional advice promptly where concerns arise;
• support with communication, including communication aids, additional time, accessible information or other strategies recommended by speech and language therapy or another relevant professional;
• support for cognitive changes, including memory, attention, perception or executive functioning difficulties;
• psychological and emotional support;
• support with continence where this has been affected;
• support with prescribed medicines and secondary stroke-prevention measures;
• access to physiotherapy, occupational therapy, speech and language therapy, dietetic services, psychology, GP services, specialist nursing and other healthcare professionals as required; and
• support to maintain relationships, meaningful activity, community participation and personal outcomes.

Staff must follow current professional recommendations contained within the individual’s records and personal plan.

Staff must not independently alter:

• rehabilitation programmes;
• swallowing recommendations;
• prescribed diets or fluid consistencies;
• medicines; or
• other clinical treatment.

Where the individual’s needs are complex or specialist, {{org_field_name}} must obtain appropriate specialist advice.

Where the service can no longer safely meet the individual’s assessed needs, even after reasonable adjustments have been considered, the requirements of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, concerning changes in assessed needs must be followed.

The personal plan must continue to be reviewed whenever the individual’s needs or personal outcomes change and, in all cases, at least every three months.

4.5 Emotional Support, Communication, Decision-Making and Dignity

A stroke may affect an individual’s emotional well-being, confidence, cognition, behaviour, communication and ability to participate in everyday activities.

Staff must provide care and support in a respectful and sensitive manner that protects the individual’s privacy and dignity and promotes autonomy and independence.

Individuals must be supported to participate as fully as possible in decisions about their care and everyday life.

A communication impairment, including aphasia or dysarthria, must not in itself be treated as evidence that an individual lacks mental capacity.

Staff must provide information in a form the individual can understand and must use any communication methods, aids, equipment or strategies identified within the individual’s assessment or personal plan.

This may include:

• allowing additional time to communicate;
• using visual information;
• using communication boards or picture-based aids;
• using appropriate electronic or assistive communication devices;
• checking that the individual has understood information; and
• obtaining advice from speech and language therapy where required.

Where there is reason to question an individual’s capacity to make a particular decision, staff must follow the Mental Capacity Act 2005 and the service’s consent and mental capacity procedures.

Capacity must be considered in relation to the specific decision at the time it needs to be made.

All practicable steps must be taken to support the individual to make the decision before concluding that they are unable to do so.

Where an individual lacks capacity for a particular decision, any decision made on their behalf must be made under lawful authority and in accordance with the Mental Capacity Act 2005, including the individual’s best interests where applicable.

Staff must recognise and respond to emotional and psychological needs following stroke.

Where concerns are identified, including:

• persistent low mood;
• anxiety;
• distress;
• emotional lability;
• social withdrawal;
• significant behavioural change; or
• other deterioration in emotional well-being,

staff must record the concern and seek appropriate professional advice or referral in accordance with the individual’s needs and wishes.

4.6 Involving Families, Representatives and Advocates

{{org_field_name}} recognises the important role that family members, representatives and advocates may have in supporting an individual following a stroke.

Their involvement must respect the individual’s:

• rights;
• wishes;
• confidentiality;
• mental capacity; and
• any lawful decision-making arrangements.

Where the individual has capacity to make the relevant decision, information about their health, care, rehabilitation or progress will only be shared with family members or other persons with the individual’s consent, unless there is another lawful basis for disclosure.

The individual’s wishes regarding who should be involved in their care and who may receive information must be established, recorded and respected.

Where a person is acting as the individual’s legally authorised representative, the service will verify and record the nature and scope of that authority and involve the representative only within the extent of that authority.

Where the individual lacks capacity to make a particular decision, staff must follow the Mental Capacity Act 2005 and any applicable lawful arrangements, including, where relevant:

• a valid and applicable health and welfare lasting power of attorney;
• a court-appointed deputy;
• a decision of the Court of Protection; or
• another lawful authority.

Family members and representatives may contribute useful information about the individual’s previous:

• abilities;
• routines;
• communication methods;
• preferences;
• wishes; and
• personal outcomes.

Such information will be taken into account as appropriate when reviewing the individual’s provider assessment and personal plan.

Where appropriate, individuals will be given information and support to access independent advocacy services.

Communication difficulties following stroke must not prevent an individual from being involved in decisions concerning their own care.

4.7 Environmental Considerations and Equipment

Where an individual’s needs change following a stroke, the environment, equipment and any required adaptations must be considered as part of the individual’s assessment and personal plan.

Reasonable and appropriate adjustments will be made where required to meet assessed care and support needs, promote independence and reduce identified risks.

This may include:

• grab rails;
• specialist seating;
• mobility equipment;
• pressure-relieving equipment;
• transfer equipment;
• communication aids;
• signage or visual prompts;
• adaptations to support orientation;
• adjustments to bedroom or communal areas; and
• other equipment recommended by an appropriately qualified professional.

Equipment and adaptations must be suitable for the individual’s assessed needs and must be used in accordance with any professional recommendations and manufacturer instructions.

Where specialist equipment is required, staff using the equipment must have appropriate training and competence.

All equipment must be appropriately:

• risk assessed;
• maintained;
• serviced where required;
• stored safely; and
• checked to ensure that it remains suitable for the individual.

Any change in the individual’s mobility, posture, cognition, communication, sensory needs or ability to use equipment safely must prompt review of relevant risk assessments, equipment requirements and the personal plan.

Where professional assessment is required, this must be requested in a timely manner.

4.8 Monitoring and Quality Improvement

{{org_field_name}} will monitor the quality and safety of stroke-related care as part of its arrangements for monitoring, reviewing and improving the quality of the regulated service.

Monitoring will include, where relevant:

• whether suspected strokes were recognised and emergency assistance was obtained without avoidable delay;
• whether the individual’s provider assessment, personal plan and associated risk assessments were reviewed following a stroke or other significant change in need;
• whether hospital discharge instructions and professional recommendations were implemented;
• whether referrals to healthcare and rehabilitation professionals were made and followed up appropriately;
• whether staff involved in the individual’s care had the required knowledge, training and competence;
• whether communication, swallowing, mobility, nutrition, hydration, psychological and other identified post-stroke needs were appropriately addressed;
• whether any prescribed equipment, adaptations or rehabilitation recommendations were implemented appropriately;
• any accidents, incidents, safeguarding concerns, complaints or avoidable deterioration associated with stroke-related care; and
• feedback from individuals and, where appropriate, their representatives.

Where monitoring identifies a shortfall, risk or failure to follow the individual’s personal plan or professional instructions, appropriate action must be taken promptly.

This may include:

• immediate action to protect the individual;
• obtaining healthcare or specialist advice;
• reviewing the individual’s provider assessment;
• revising the personal plan or risk assessments;
• additional staff supervision or training;
• review of staffing arrangements;
• review of equipment or environmental arrangements; and
• changes to organisational systems or working practices.

Learning from incidents, complaints, feedback, audits and professional advice must be used to improve care, staff practice, training and organisational systems.

Relevant findings will inform the service’s wider quality monitoring arrangements and the Responsible Individual’s quality of care review and report, as applicable.

Records must demonstrate:

• the concern or improvement area identified;
• the action taken;
• who was responsible for the action;
• any required timescale; and
• subsequent monitoring to confirm whether the action was effective.

5. Policy Review

This policy will be reviewed annually or sooner if there is a change in legislation, guidance, or in response to an incident or organisational need. Reviews will ensure alignment with the latest CIW expectations and national standards of stroke care in Wales.

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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}}
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