Starting a Thrombolysis service

342 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
342
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Starting a Thrombolysis service

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

×