Authors (including presenting author) :
Yuen WT(1), Chu KW(1), Cheung YH(1), Lam CM(1), Kwok Y(1)
Affiliation :
Department of medicine, Haven of Hope Hospital
Introduction :
At Haven of Hope Hospital's Ward 3L, we care for postoperative hip and knee replacement patients who are at increased risk for stroke. Recent findings by Pang (2024) highlight a strong correlation between these surgeries and stroke risk. Observations indicate a significant gap in staff awareness and training regarding stroke management, as many focus primarily on orthopedic care. Addressing this issue requires ongoing education to help healthcare professionals identify high-risk patients and recognize early stroke symptoms, leading to prompt activation of stroke management protocols (Rababah, Al-Hammouri, & AlNsour, 2021).
Objectives :
1)To empower staff to activate fast-track stroke management efficiently. 2)To sustain the quality of nursing management for strokes through reference guides and simulation drills. 3)To prevent the oversight of inpatient strokes during patient deconditioning.
Methodology :
The program consisted of five key components aimed at enhancing staff awareness and skills in stroke management. First, a stroke nurse consultant demonstrated assessment techniques and effective communication skills during activation, emphasizing timely stroke activation without overlooking critical aims. Next, critical points were extracted from a training video on neurological assessment developed by the KEC neurology nursing team. In a training session, staff watched the video and then performed return demonstrations on these critical points to trainers, with each trainer pairing with a staff member to ensure 100% performance. Additionally, a six-page quick reference guide was created to assist staff in conducting rapid stroke assessments at the bedside. Stroke management scenarios were integrated into ward operational drills to provide practical experience in identifying and responding to stroke symptoms. Finally, a system was established to document the baseline neurological status of high-risk patients upon admission, ensuring stroke risk is not overlooked during patient deterioration.
Result & Outcome :
The program significantly improved staff awareness of acute stroke risks in orthopedic postoperative patients. Notably, 100% demonstrated compliance in return demonstrations for neurological assessment. All 18 nursing staff were interviewed, with 12 (67%) strongly agreeing and 6 (33%) agreeing that their skills improved. Additionally, 14 (78%) strongly agreed and 4 (22%) agreed that the cue card was practical for managing patient deconditioning. All staff acknowledged that incorporating acute stroke management in drills helps maintain nursing knowledge and they agreed that documenting baseline neurological status aids in early stroke detection. Future steps will structural approaches to evaluate the quality of nursing assessments, as well as assessing activated stroke cases and missed cases to enhance learning and patient outcomes.
