Starting a Thrombolysis service
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Starting a Thrombolysis service

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Starting a Thrombolysis service Starting a Thrombolysis service Presentation Transcript

  • Starting a Thrombolysis service Tony Kenton Consultant Neurologist, UHCW Clinical Lead, Coventry and Warwickshire Cardiovascular Network
    • DON’T DO IT!!
  • Learn From Cardiology
  • Models of Acute Stroke Units
    • Hyperacute
    • Hyperacute and acute
  • Staffing
    • Which consultants
    • Junior cover/EWTD/New deal
    • On-call
    • Nurses/training
    • Therapy staff
  • Thrombolysis
    • Speed, speed, speed
  • Stroke Onset
    • Awareness
      • Patient/witness
      • GP/practice
      • Health care workers
  • Initial Assessment
    • Paramedics
    • FAST test
    • Which hospital
    • Pre-alert
    • Take a witness/iv line etc
    • ‘ stay and play’ OR ‘scoop and run’
  • Arrival at Hospital
    • Who does initial assessment
      • ED/medics/stroke nurse/stroke dr
    • How are they trained to assess the patient
    • What if it is not a stroke
      • Can they recognise stroke mimics
      • Who do they refer to
    • Protocol for BP, bloods, ecg, arranging CT
  • CT Scan
    • Radiographer
    • Someone to interpret the CT
    • Are radiographers resident/travel time
    • When do they get called
    • Interpreter training?
  • Post Thrombolysis
    • Intense nursing assessments
      • BP, GCS/NIHSS, other parameters
    • Who do they call if something goes wrong
    • Need a detailed protocol
  • Follow Up
    • Audit
      • Treated and untreated patients
    • Ongoing education
    • Continual refining of the pathway
    • ‘ Nip things in the bud’
    • Adopt new guidelines/treatment
  • Summary
    • Set up your hyperacute unit first
    • Involve all stakeholders
    • Education: treating acute stroke is good
    • Make sure most people are happy with the service
    • Clear guidelines/protocols
    • Feedback and follow up
    • Be able to change and adapt
  • It’s About Change…
    • Everyone thinks of changing the world, but no one thinks of changing himself.
    • Leo Tolstoy
    • You must be the change you wish to see in the world.
    • Mahatma Gandhi.