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NATIONAL STROKE AUDIT (2004)

By Chris Kelly,2014-06-28 13:20
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NATIONAL STROKE AUDIT (2004) ...

    Patient audit number [ ]

     ROYAL COLLEGE OF PHYSICIANS NATIONAL SENTINEL STROKE AUDIT 2008

    CLINICAL AUDIT PROFORMA

The patient should be selected from the first 60 consecutive cases with a primary diagnosis of

    stroke (ICD 10 codes: I61, I63 and I64 or ascertained via other methods) admitted to the Site

    between 1st April 30th June 2008. See accompanying help booklet for full methodology and data definitions.

SITE CODE: [ ]

Auditor Discipline (tick all that apply)

A1) Clinical Audit Medicine Nursing Therapy Other

     Specify ________

DEMOGRAPHIC INFORMATION

    B1) Patient audit number: [ ]

B2) Date of Birth: [ ]/[ ]/[ ] (dd/mm/yyyy)

    B3) Gender: Male Female

    Definition of hyperacute care

Usually up to the first 72 hours of care after a stroke in a unit equipped where appropriate to provide

    thrombolysis and other acute interventions

B4 Did you provide stroke care for the whole episode (ie hyperacute, Yes No

    acute and rehabilitation) for this patient?

If yes go straight to B6

If no, did you provide (i) Hyperacute care only

     (ii) All inpatient care apart from hyperacute

     (iii) Rehabilitation only

    If no to B4 and (i) is selected, and this episode of care was part of a formal agreement to provide

    hyperacute care for another trust do NOT complete the rest of this form. Provide information

    about this aspect of care to the hospital the patient is repatriated, so that they can complete a

    proforma for the total episode including the hyperacute care you have provided.

    Site code of collaborating hospital [ ] (Contact RCP Administrator to obtain site

    code)

If no to B4 and (ii) is selected, and all hyperacute care was provided at another Trust/site complete all

    the dataset including the detail of the hyperacute spell by contacting the hyperacute site

Site code of collaborating hospital [ ] (Contact RCP Administrator to obtain site code)

If no to B4 and (iii) is selected and you are a rehab only site provide the site code of the collaborating

    hospital: [ ] (Contact RCP Administrator to obtain site code) and omit the following

    questions:

    Stroke Clinical Audit Proforma 2008

    1.7, 1.7i, 1.9, 1.9i, 1.13, 1.13i, 1.13ii, 1.13iii, 1.13iv, 1.14, 2.2, 2.5, 3.2 and 3.4

B5) Site code of collaborating hospital: [ ] (Contact RCP Administrator to obtain site

    code)

     Date of transfer to your site [ / / ] (dd/mm/yyyy)

B6) Was the patient already an inpatient at the time of stroke? Yes No

     If yes omit questions 1.7 and 1.7i

SECTION 1 STROKE ONSET AND HOSPITAL STAY

    Please make every effort to find the date and time of stroke

    1.1 Date of stroke: [ / / ] This date is precise

     dd /mm/yyyy This date is a best estimate

    1.1i Time of onset of stroke: [ ] HH/MM (24 hr clock)

    Not known

    1.1ii If time is not known state the reason:

    Not known because stroke occurred during sleep

    Not known for other reason

1.2 Date of admission: [ / / ]

     dd /mm/yyyy

     stn.b. the patient should have been admitted between 1 April 2008 and 30 June 2008

    1.2i Time of admission [ ] HH/MM (24 hr clock)

     Not known

    1.2ii Age at admission: [ ] years (This will be calculated automatically when

    you enter dates online) n.b must be >16 years

1.3 Did the patient die whilst still an inpatient? Yes No

    1.3i If No, at the time of audit is the patient

    still in hospital for this episode?

    been discharged?

1.4 Date of discharge (If discharged alive): [ / / ]

    (dd/mm/yyyy)

     1.4i Length of stay to discharge alive: [ ] days

     (This will be calculated automatically when you enter dates online)

    1.5 Date of death: [ / / ] (dd/mm/yyyy)

    1.5i Or date of death not applicable

    ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 2

    Stroke Clinical Audit Proforma 2008

     1.5ii Time from stroke (or date of admission if not available) to death: [ ] days

     (This will be calculated automatically when you enter dates online)

1.6 Was the patient alive at 30 days after stroke? Yes No Not

    known

     (If no enter date of death in Question 1.5)

ADMISSION/DISCHARGE

1.7 Do you have a copy of the ambulance clinicians’ patient Yes No No but

    records on file for this patient?

    1.7i If yes, did this include a FAST test? Yes No

Answer No, but… if: patient did not arrive by ambulance

1.8 Was the patient treated in a Stroke Unit (or units) at any time Yes No

    during their stay?

    (as defined by the 2008 Organisational Audit refer to the Organisational help booklet)

     1.8i If yes, which type(s) of stroke unit did they spend time in? (Tick all that apply)

     Acute stroke unit

     Rehabilitation stroke unit Combined stroke unit

1.9 Was the patient admitted to an Acute or Combined Stroke Unit Yes No

    within 4 hours of arrival at hospital?

    1.9i If No, where were they initially admitted to?

     Admissions/medical assessment unit/clinical decisions unit

     Coronary care unit

    Intensive care unit/High dependency unit

     Rehabilitation stroke unit

     Other ward

1.10 Where did the patient spend over 50% of their stay (calculate from time of stroke if stroke

    occurred in hospital)?

    Admissions/medical assessment unit

    Coronary care unit/Intensive care unit

    General/geriatric ward

    Stroke unit of any type (ie acute, rehab or combined)

    Generic rehabilitation unit (ie not a stroke rehab unit)

    Other

    Specify______________

1.11 Date of admission to stroke unit [ / / ] (dd/mm/yyyy)

1.12 Date of discharge from stroke unit [ / / ] (dd/mm/yyyy)

    ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 3

    Stroke Clinical Audit Proforma 2008

SCAN

1.13 Did the patient have a brain scan after the stroke? Yes No Not known

If No,

    1.13i Reason the patient did not have a scan:

    Patient refused/unable to co-operate

    Palliative care

    Scan not routinely available

    Not considered clinically indicated

    Other

    If other, specify ________________________

If Yes,

    1.13ii Date of first brain scan after the stroke [ / / ] (dd/mm/yyyy)

    *Please make every effort to find the date and time of scan

    1.13iii Time of first brain scan after the stroke [ ] HH/MM (24 hr Clock)

     Not known

    1.13iv Has a brain scan been carried out within 24 hours of the stroke?

    Yes No Not known

    1.14 Following the scan what was the pathological diagnosis? (If scan normal in the presence of stroke symptoms/signs then classify as infarction)

    Infarct

    Haemorrhage

ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 4

    Stroke Clinical Audit Proforma 2008

SECTION 2 CASEMIX

CO-MORBIDITIES and RISK FACTORS

    2.1 Did the patient have any of the following co-morbidities prior to admission? Yes No

     2.1i If yes, please select all that apply

     Atrial fibrillation

     Previous stroke or TIA

     Diabetes mellitus

     Hyperlipidaemia (total cholesterol >5 or LDL >3.0 mmol/L)

     Hypertension (systolic >140 or diastolic >85)

     Myocardial infarction or angina

     Valvular heart disease (aortic or mitral valves)

    2.2 Did the patient have any of the following risk factors? Yes No

    2.2i If yes, please select all that apply

    Current smoker Alcohol excess (no of units per week > 21 for females, > 28 males)

PRE-ADMISSION MEDICATION

    2.3 Was the patient on any lipid lowering treatment before admission? Yes No

    2.4 Was the patient independent in everyday Yes No Not known

    activities before the stroke?

    (e.g. Barthel 19-20, Rankin <3)

DURING ADMISSION

2.5 Did the patient have any of the following during the first 24 hours?

    i Dysphasia Yes No Not known

    ii Dysarthria Yes No Not known

    iii Motor deficits Yes No Not known

    2.6 Did the patient have a urinary tract infection in the first 7 days Yes No as defined by having a positive culture or clinically treated?

2.7 Did the patient receive antibiotics for a newly acquired pneumonia

     during their admission after stroke? Yes No

    2.8 What was the worst level of consciousness at the time of maximum severity within the first

    week after stroke?

     Fully conscious

     Drowsy

     Semi-conscious (not fully rousable)

     Unconscious (responds to pain only/no response)

ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 5

    Stroke Clinical Audit Proforma 2008

2.9 Dependency at discharge (using the Barthel ADL Functional Assessment Scale)

    Bowels 0 = Incontinent (or needs to be given enemata) 0

    1 = Occasional accident (once/week) 1

    2 = Continent 2

    Bladder 0 = Incontinent, or catheterised 0

    1 = Occasional accident (max once per 24 hrs) 1

    2 = Continent (over 7 days) 2

    Grooming 0 = Needs help with personal care 0

    1 = Independent face / hair / teeth / shaving 1

    (implements provided)

    Toilet Use 0 = Dependent 0

    1 = Needs some help, can do something alone 1

    2 = Independent (on and off, dressing / wiping) 2

    Feeding 0 = Unable 0

    1 = Needs help cutting, etc 1

    2 = Independent (food in reach) 2

    Mobility 0 = Immobile 0

    1 =Wheelchair independent including corners etc. 1

    2 =Walks with help of one person (verbal or 2

    physical)

    3 = Independent (may use stick etc.) 3

    Transfer 0 = Unable - no sitting balance 0

    1 = Major help (one / two people) can sit 1

    2 = Minor help (verbal or physical) 2

    3 = Independent 3

    Dressing 0 = Dependent 0

    1 = Needs help, can do half unaided 1

    2 = Independent (including buttons, zips, laces etc) 2

    Stairs 0 = Unable 0

    1 = Needs help (verbal/physical) 1

    2 = Independent 2

    Bathing 0 = Dependent 0

    1 = Independent 1

Total [ ] (will only be calculated on website if all sections completed)

2.10 Was the patient newly institutionalised at discharge? Yes No Not

    Known

ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 6

    Stroke Clinical Audit Proforma 2008

SECTION 3 STANDARDS WITHIN 72 HOURS

FIRST 24 HOURS

     3.1 If the patient is alert and able to communicate, is there a formal Yes No No assessment of? but i Visual fields ii Sensory testing Answer No, but… if: impaired level of consciousness/communication is documented.

3.2 Was the patient prescribed Alteplase (tPA) for stroke Yes No

    3.2i Date Alteplase started [ / / ] (dd/mm/yyyy)

     ii Hour Alteplase started [ ] HH (24 hr clock)

     iii Was this as part of a randomised controlled trial? Yes No

    3.3 Has screening for swallowing disorders (not gag reflex) been Yes No No

     specifically recorded in the first 24 hours? but

Answer No, but if: impaired level of consciousness is documented.

FIRST 48 HOURS

    3.4 Has the patient commenced aspirin or, where contraindicated, an Yes No No alternative antiplatelet (e.g. clopidogrel) by 48 hours after stroke? but

Answer No, but... if: patient is receiving palliative care; patient died; patient has intra-cerebral

    haemorrhage.

FIRST 72 HOURS

    3.5 Has swallowing been assessed within 72 hours of admission (or of stroke if the stroke occurred in hospital) by a speech and Yes No No language therapist or other professional trained in dysphagia but assessment (i.e. not screening)?

Answer No, but... if: patient's swallowing is documented as normal; patient is still unconscious;

    patient died within 72 hours; patient is receiving palliative care.

    3.6 Has the patient been assessed by a physiotherapist within 72 Yes No No hours of admission (or of stroke if the stroke occurred in hospital)? but

Answer No, but... if: patient died within 72 hours; patient is receiving palliative care; patient has no

    motor deficit

    ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 7

Stroke Clinical Audit Proforma 2008

ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 8

    Stroke Clinical Audit Proforma 2008

    HYDRATION AND NUTRITION

3.7 Was the patient receiving fluids within 24 hours of stroke either

    orally, intravenously or parenterally? Yes No No

    but

    Answer No, but... if: patient refused or patient receiving palliative care

3.8 Was the patient receiving nutrition within 72 hours of admission?

    NB This means nutrition and not simple IV fluids eg Dextrose solution

    Yes No No but

    Answer No, but... if: patient refused or patient receiving palliative care

    3.8i If yes, which of the following methods was used? (tick all that apply)

    Oral . Nasogastric/PEG

     Parenteral

3.9 Was the patient screened for malnutrition using a malnutrition Yes No No but

    screening tool (e.g. Malnutrition Universal Screening Tool)?

    Answer No, but…if patient receiving palliative care; patient died

SECTION 4 STANDARDS WITHIN 7 DAYS

WITHIN SEVEN DAYS

4.1 Has there been an initial assessment of

    communication problems by the speech and language

    therapist within 7 days of admission (or of stroke if the stroke

    occurred in hospital)? Yes No

    No but

    Answer No, but... if: patient died within 7 days; the patient was still unconscious; it is documented that the patient had no communication problems; patient is receiving palliative care.

4.2 Was the patient assessed by an occupational therapist

    within 4 working days of admission (or of stroke if the stroke

    occurred in hospital)? Yes No No

    but

    Answer No, but... if: patient died within 4 working days; the patient was still unconscious; it is documented that the patient had no difficulties performing everyday activities; patient is receiving

    palliative care.

If no, 4.2i Was the patient assessed by an occupational therapist

    within 7 days of admission (or of stroke if the stroke

    occurred in hospital)? Yes No No

    but

    Answer No, but... if: patient died within 7 days; the patient was still unconscious; it is documented that the patient had no difficulties performing everyday activities; patient is receiving palliative care.

    ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 9

    Stroke Clinical Audit Proforma 2008

4.3 Did the patient have an indwelling urinary catheter in Yes No

    the first week after admission?

    4.3i If yes, which of the following have been documented as the reason for urinary

    catheterisation?

Please select all that apply

    a. urinary retention

     b. pre-existing catheter

     c. urinary incontinence

     d. need for accurate fluid balance monitoring e. critical skin care f. not documented g. other please specify _____________

4.4 Is there a plan to promote urinary continence?

     Yes No No

    but

    Answer No, but... if: patient is continent; patient died within 7 days; patient is unconscious; patient is receiving palliative care.

SECTION 5 BY DISCHARGE

5.1 Is there evidence that the patient was weighed Yes No

    No but

    at least once during admission?

    Answer No, but... if patient died within 7 days; patient unconscious or receiving palliative care.

5.2 Is there evidence in the multidisciplinary notes of a social work

    assessment within 7 days of referral? Yes No

    No but

    Answer No, but... if: patient not referred to Social Worker; patient died within 7 days; or patient refused.

5.3 Is there evidence that the patient's mood has

    been assessed? Yes No

    No but

    Answer No, but... if: patient unconscious throughout; or patient died within 7 days.

5.4 Is there evidence that the patient's cognitive Yes No

    No but

     status has been assessed?

    Answer No, but... if: patient unconscious throughout; or patient died within 7 days, or receiving palliative care.

ICSWP National Sentinel Stroke Clinical Audit 2008. Copyright Royal College of Physicians 2008 10

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