TIA and Stroke Services at East and North Hertfordshire NHS TrustThis site is to provide information for patients and their families and friends, staff and nursing and medical staff. Please also see the Official site Diagnose stroke using the FAST testFAST requires an assessment of three specific symptoms of stroke. If any of these are present then Time to call 999. Stroke is a medical emergency and by calling 999 you can help someone reach hospital quickly and receive the early treatment they need. Prompt action can prevent further damage to the brain and help someone make a full recovery. Delay can result in death or major long-term disabilities, such as paralysis, severe memory loss and communication problems (aphasia). Locally the patient should be blue-lighted to the Lister hospital for consideration for thrombolysis. Note that patients even from Welwyn will be taken to the Lister rather than QE2 hospital initially. This however means that the patient will see specialists quicker. Stroke is a devastating disease but the management and outlook for patients has changed greatly in the past decade with the use of stroke units staffed by specialist doctors, nurses and therapists and better diagnostic techniques and new treatments. The East and North Hertfordshire NHS trust has invested in stroke and we now have two units, one at the Lister and another at the QE2 for patients with stroke. Each one fulfills a slightly different role. Hyperacute Stroke Unit (HASU) at the Lister Hospital 6ASAt the beginning of November 2009 the East and North Herts NHS trust opened a Hyperacute stroke service at the Lister Hospital. This enables us to provide all of the fundamental skills required in the first few hours and days of acute stroke care in the correct place. The hyperacute stroke unit is on level 6A South. The unit contains up to 10 beds. Patients will stay here for several days before being moved to the Stroke Rehabiliation ward at the QE2 Hospital. It is important to managing the stroke service that patients are moved when appropriate so as to allow new patients to be admitted. This is all part of what is known as the "stroke pathway". The hyperacute stroke unit provides
Stroke ThrombolysisStroke thrombolysis is an important treatment for improving outcome for those with an ischaemic type stroke who come to us within 3 hours from the onset of the stroke. Currently there are restrictions on its use. It is only licensed for those aged 18 to 80 years old and who come to hospital within 3 hours of the stroke starting. Before treatment all patients need to have a CT brain scan. The service is only avalable from 9 to 5 monday to friday but the trust is already devoting resources and training so that we can eventually provide this service 24/7. Acute Stroke Rehabilitation Unit at the QE2 Hospital, Welwyn Garden CityProvides Patients should be transferred to bayford after 48 hours though there is always some flexibility as patients who are medically unstable may be kept longer on 6AS. Bayford ward on the QE2 site has been the location for the stroke unit for the East and North Hertfordshire trust since 2007. There are 24 beds and each bay contains single sex bays and access to single sex toileting facilities. There are four side rooms with ensuite facilities and these are reserved mainly for those who require isolation. Patients admitted to the Lister Hospital with Strokes are transferred to Bayford ward as soon as possible. Bayford ward is a rehabilitation unit but as soon as patients can be moved onto the community rehabilitation beds in St Albans, Welwyn and Bishop Stortford, Hitchin and Royston they are transferred for ongoing rehabilitaiton in the community. Patients who improve quickly can continue their therapy at home. Many strokes are mild and patients can recover quickly. For others stroke can be a devastating event for both the patient and their loved ones. No two patients or strokes are the same and all patients have different needs and experiences. However many patients do very well and can return home to family and carry on with life. Some go back to work and others back to enjoy their retirement. On Bayford we try to individualise the needs of each patient. It is a worrying time for all and we hope that some of the information here will answer some of your questions. If you wish to know more please talk to the staff on the ward. Stroke thrombolysis is a new treatment for stroke patients. It has been shown to reduce disability but must be given within 3 hours of the start of the stroke. Patients need to have a thorough evaluation by a specialist and a CT brain scan before it can be given. Currently it is only available during office hours. There is currently a huge effort going on into extending this to evenings and weekends and eventually a 24/7 service. The Multidisciplinary Stroke TeamAbout the team : Stroke Care is not provided by just one team of professionals but by a group of professionals with different skills all working together. Evidence shows that this is the best approach to stroke care and works best for patients. Decisions are made as part of a team and in close communication with the patient and their family Doctors : The medical care will be managed by a team of doctors led by the Stroke Consultant. If you would like to speak to the medical team then speak to any of the nurses or ask to speak to the doctors when you are on the ward. It is best to make contact during office hours as the main team are not always around in the evenings or at weekends. Stroke Specialist Nurse : The stroke specialist nurse is available from your admission to hospital until you leave to guide you and your family and carers through your stroke pathway. Questions or any concerns you may have relating to your care will be answered and further stroke care prevention information is offered. The stroke specialist nurse works closely with all areas of the trust to co-ordinate expert stroke care and ensure your progress is encouraged. The stroke specialist nurse can be contacted on 01438781083, 01707 369095 or alternatively ask one of the nurses on the ward to make contact. Nursing Sisters and nursing staff : The ward is managed by one senior sister (Sister Bruton) (wearing navy blue) and two junior sisters (wearing royal blue). The nursing team is made up of staff nurses (wearing stripy blue tunics), healthcare assistants (wearing stripy grey tunics) and student nurses. The Nurses have 24 hour responsibility for your care. They will be involved with planning and delivering your nursing needs. They work closely with the other members of the multidisciplinary team to co-ordinate your care. Physiotherapy : The physiotherapists on the ward wear white tunics with a blue stripe and blue trousers. A physiotherapist will assess your initial problems as a result of the stroke, which may include weakness, loss of sensation or co-ordination, poor balance and mobility. You will be seen for treatment regularly to address these problems either in the gym or by your bedside. The treatment may include sitting practice, transfer practice, reaching, and exercises and will hopefully progress to walking practice as appropriate. You will be expected to participate to the best of your ability and carry out specific exercises in your own time, to supplement the therapy sessions and improve your chances of making a good recovery. Occupational Therapy : The occupational therapists on the ward wear white tunics with green stripes and green trousers. Occupational Therapists will help you to achieve your optimum independence in a range of activities, occupations and life roles that are important to you. This can include self care, domestic tasks, leisure and work. Initial assessments are individualised to your needs and will include a range of aspects, such as:- physical, sensory , cognitive, perception and mood. Difficulty in any of these areas will lead to difficulties in every day activities. The Occupational Therapist will guide you/ your family/ carer in ways to minimise these difficulties. We will agree specific goals with you that will guide your rehabilitation plan. As part of your move from the unit, a coordinated plan will be agreed with you and the team. This may include an Occupational Therapy Assessment of your home environment to determine equipment and/ or any practical support and further. Occupational therapy also run an ‘upper limb’ group once a week. The aim of the group is to help patients maximise functional activity in their affected arm. Speech and Language Therapy : You may see a Speech and Language Therapist if you are having difficulty swallowing or have a problem with your communication. Dietician : You may need to see the Dietician if you have a poor appetite or have any special dietary requirements. You will also be seen by the Dietician if your swallow has been found to be unsafe and you need to be fed via a tube. Social Worker: The role of the social worker is to assess, where appropriate, care needs for discharge from hospital. This includes assistance with finding a 24 hour care facility or possibly a package of care in a persons own home. It is a means tested service. Please contact the social work team with any queries on 01707 365 145 or alternatively ask one of the nurses to make a referral.
Multidisciplinary MeetingsAll members of the team meet at least once a week usually on a Tuesday morning at 6A South and in the afternoon at Bayford to discuss progress. The therapists also have their own meeting on a Monday afternoon to talk about rehabilitation issues in greater detail. We also aim for every patient to have a family meeting at an appropriate time during their stay. We will discuss individual care needs and agree meaningful goals which will guide your specialist rehabilitation plan and your transfer from the unit. Ward Cover : Patients are seen by therapists on most weekdays unless the patient is too unwell. The medical team sees all the patients daily Monday to Friday and when asked to do so at weekends and overnight. In the mornings the wards are busy with general nursing care and therapy and doctors rounds and it is a busy working area so visiting is discouraged until afternoon. Visitors are only allowed in exceptional circumstances.
MiscellaneousInfection control : It is very important to maintain high standards of health and safety therefore hands should wash your hands when entering and leaving the ward and use the alcohol gel provided. Gowns and gloves should be worn when applicable (indicated by the yellow notices). If you have any queries please speak to a nurse first. Food and Drink : Meal times are approximately 8 am, 12 noon and 5.30 pm Meals are ordered daily. You may need to have a special diet or you may need assistance with feeding especially early in your stay on the unit. Some patients may even be Nil By Mouth We are not allowed to heat up food on the ward but cold items can be brought in, labelled and put in the ward fridge. It is important to check with staff first to find out what that patient is allowed to eat/drink for their own safety. Clothes and Amenities : Patients are encouraged to dress in loose day clothes as early as possible in their stay on the unit (joggers, t- shirts and comfortable flat outdoor shoes). Towels will be provided on the ward. Patients will need to have their own clothes and wash items brought in from home. We do not have facilities to wash patients clothes, so clothes for washing will be left in a laundry bag in the lockers normally. Visiting. Family, friends and carers are invited where appropriate to come out of visiting times if they wish to participate in therapeutic activity. For example; to assist with feeding, or to contribute to a physiotherapy or occupational therapy treatment sessions. This may be particularly relevant prior to your transfer from the unit. Chaplain : Patients/family members/carers need to inform the nursing staff if the patient wishes to be seen by the Chaplain so this can be booked. Visiting Times : Visitors are important for the patient but need to realise that after a stroke patients have a lot of fatigue and need rest. They will need to go for therapy and many medical tests and procedures may happen in the afternoons. If you have any questions please ask the nursing staff. Privacy and Confidentiality : There are very important and the ward staff will be very reluctant to divulge information without the consent of the patient except to the next of kin and close family. At times if you are on the ward during a ward round or where a patient is unwell you may be asked to leave the bay temporarily. Follow-up : Most patients are seen in clinic at 4-6 weeks after discharge. This may be at either the Lister or QE2 Hospitals. Driving : Those who make a good and full recovery can resume driving after 28 days from the stroke or TIA. You will be advised by the doctor. Those with any residual weakness or visual problems must discuss driving with the medical team. The patient is also obliged to inform the DVLA in Swansea and their Car Insurance company. If the DVLA allow the patient to resume driving it is best to take things very easy at the start until confidence and lost skills are regained.
Monitoring on the ward and other informationBlood Pressure : This is monitored closely in the hours and days following your stroke. High blood pressure is one of the most common causes of stroke. However we go very gently with lowering blood pressure after a stroke as lowering it too quickly can cause problems. Heart rate : Is often a good sign of things being well. If the pulse is abnormal then the doctors would be asked to see the patient. Temperature : Is often elevated in someone with a stroke but can also suggest the onset of an infection - most commonly chest infection or urinary things being well. If the pulse is abnormal then the doctors would be asked to see the patient. Blood glucose (sugar) : is usually measured in patients who are diabetic Urinalysis: this is urine testing and is done if a urine infection is suspected
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