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Stroke in Care Homes (Wales) Policy

Policy Statement

The aim of this policy is to ensure that {{org_field_name}} provides the highest possible quality of care for people using services who suffer from a stroke, are recovering from stroke or who have suffered disability through stroke.

Its care of stroke victims will always be in line with its duties to meet the requirements for person-centred care set out in the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 and statutory guidance.

{{org_field_name}} understands a stroke to be a type of brain injury which occurs when the blood supply to any part of the brain is interrupted and results in tissue death and subsequent loss of brain function. The home understands the treatment of stroke to principally involve rehabilitation and the prevention of future strokes, the key goal of treatment being to prevent the spread of the stroke and to maximise the person using services’ ability to function and regain their independence as far as is possible.

In acute cases of stroke, the home understands that, with the growth in recent years of acute stroke teams and acute stroke units providing thrombolysis (the breaking down of blood clots), the prognosis for stroke victims is now vastly improved provided they can access treatment as soon as possible. Care of acute stroke cases therefore depends upon obtaining emergency medical treatment as quickly as possible once symptoms have been recognised.

{{org_field_name}} believes that adherence to strict guidelines and care standards is of paramount importance in ensuring the safety of both people who use services and staff and in providing high-quality, individualised care.

The home adheres to the National Clinical Guidelines for Stroke, developed by the intercollegiate working party of the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.

Care of Stroke

1. Staff will call for an ambulance immediately if any person who uses services appears to be suffering from any of the symptoms of a stroke, ie facial weakness, arm weakness or speech problems.
2. The agency has appropriate professional links with local specialist stroke services and has up-to-date contact numbers and details readily available.
3. Contact details for local stroke services are as follows: __________________________.
4. Staff will check to ensure that appropriate discharge planning is completed prior to the transfer from a hospital or specialist stroke unit to {{org_field_name}} of any person who has suffered a stroke. It is imperative that the home is well prepared and ready for the arrival of anyone with a history of stroke so that individualised care of the highest possible quality can be provided to meet their needs and any continuing treatment required can be provided and supported seamlessly without delay by a specialist service in the community, day hospital or outpatient clinic.
5. Staff have a duty to co-operate with and work with any treatment plans provided by specialist stroke rehabilitation services for any person who has suffered a stroke, including working to support stroke rehabilitation services in maximising the independence and self-caring abilities of those recovering from stroke.
6. A full risk and multidisciplinary care assessment will be carried out on any person who has suffered a stroke — the assessment should be performed by appropriately trained staff with input from appropriate care professionals as part of the care planning process and the details of the assessment recorded in the individual’s plan and regularly reviewed.
7. High-quality ongoing care will be provided by all care staff in accordance with each person’s plan.
8. People will be referred to and seen by appropriate healthcare professionals for specialist rehabilitation advice or support to be provided where required, eg a speech and language therapist in the event of a person using services having difficulties with swallowing, a physiotherapist to help mobility and keep the lungs clear, an occupational therapist to advise on necessary equipment and adaptations, etc.
9. Any specialist equipment or adaptations will be provided to the person’s living environment wherever required, eg a special mattress designed to prevent pressure sores, special equipment such as a hoist or wheelchair to ensure they are moved safely, communication aids and eating aids, etc.
10. All staff are appropriately trained and supervised in the care of stroke.
11. Staff training on the care of stroke is the responsibility of: _____________________________.
12. Staff have all necessary equipment and training in moving and handling, in order to position and transfer people safely.
13. The dignity of people using services recovering from stroke will be maintained at all times.

Support Provided by Care Staff

Staff will be trained to be aware of the impact that having a stroke can have on the psychosocial, physical and cognitive functions of a person. The home will expect care staff to:

1. recognise and accept that feelings of depression, anger, frustration and bewilderment are all common, especially in the early stages of recovery
2. always try to be understanding, positive and patient when talking to someone recovering from stroke
3. motivate and support the person to be as active and socially involved as they wish to be
4. recognise that some stroke survivors may have aphasia, an impairment of language ability, which can cause disruption to language and speech, or dysphagia, which includes problems with swallowing
5. support and collaborate with speech therapy treatment regimes wherever appropriate
6. speak clearly to ensure they are understood and be patient when the person is replying
7. support physiotherapy treatment plans and help the person to complete their exercises, helping the person suffering from a stroke to be as active as possible as soon as they can after their stroke
8. where necessary help with feeding, drinking, bathing, washing and dressing with respect, sensitivity, tact and discretion in such a way that the person’s independence is supported and their dignity upheld.

Stroke Prevention

In {{org_field_name}}, the prevention of stroke will be given a high priority. The home understands that the key elements in stroke prevention are:

1. healthy diet
2. regular exercise
3. avoiding smoking or excessive alcohol consumption.

In {{org_field_name}}, therefore, the following applies.

1. Access to health promotion information and services relating to stroke prevention will be provided.
2. All food served will be of high quality and menus will be designed to give as many healthy food choices as possible while offering people a choice of foods that they like.
3. Healthy eating information will be made available to all people who use services.
4. Access to a dietician will be encouraged wherever needed.
5. Specialist diets or low-fat, high-fibre diets which include plenty of fresh fruit and vegetables will be made available to people who require such a diet.
6. Opportunities for regular exercise will be provided, along with the necessary support and encouragement.
7. Smoking is banned in the home except for a smoking room for people who use services.
8. People who use services who smoke are given access to a range of smoking cessation support and public health information and guidance if they require it.
9. People who use services are given access to a range of public health information and guidance relating to excessive alcohol consumption and will be actively supported to reduce their consumption levels if they wish.

FAST

With the growth in recent years of acute stroke teams and acute stroke units providing thrombolysis (the breaking down of blood clots), the prognosis for stroke victims is now vastly improved provided they can access treatment as soon as possible. The FAST campaign aims to educate people on the signs of stroke and encourages them to spot the signs and to call the emergency services immediately and not to delay by calling for less responsive forms of help.

FAST stands for the following.

• Facial weakness.
• Arm weakness.
• Speech problems.
• Time to call for emergency help.

Any staff seeing any of these signs is encouraged to treat it as an emergency and to call an ambulance immediately.

Training

The appropriate care of stroke sufferers requires specialist skills and all care home staff who provide care for people suffering with stroke will be appropriately trained and supervised according to the demands of their role. This will include:

• specialised training courses in the care of stroke sufferers
• joint training with local specialist stroke rehabilitation staff.

In addition to the treatment and care of those who have suffered a stroke in the past, care staff will also be trained to recognise the signs and symptoms of somebody in the acute phase of having a stroke.

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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: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

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