There are more than 100,000 strokes in the UK each year – that’s around one stroke every five minutes. Stroke is the fourth single leading cause of death in the UK and largest cause of disability, with over 1.2 million stroke survivors in the UK. At Livewell Southwest, people newly diagnosed with an acute stroke are cared for by our Stroke Rehabilitation team.
Based in Mount Gould Local Care Centre’s Skylark Ward, the Stroke Rehabilitation Unit (SRU) provides beds for up to 15 people at a time, with their work for each patient starting before they’ve even reached the ward.
Donna Berry, stroke clinical nurse specialist, visits University Hospitals Plymouth’s acute stroke ward, Merrivale, each week to meet with the patients on the ward, their families or carers, and the team caring for them.
Donna said: “When I visit the acute stroke unit I attend the multidisciplinary team (MDT) meeting and as a team we discuss how individual stroke survivors are recovering, reviewing the CT head scans and discussing how the imagery translates into physical presentation. The team discuss progress towards goals and whether the person is suitable for stroke rehabilitation.
“I will then aim to speak to those people referred for rehabilitation and discuss what is to be expected. It is a great opportunity to speak with family members, discuss any worries they may have about stroke recovery and manage any expectations they may have.”
At the SRU, care is provided by the multidisciplinary team which includes a stroke rehabilitation consultant Dr Jacob Benjamin, Dr Ravindran the SRU speciality doctor, a physiotherapy team led by Sarah Billings, occupational therapy team led by Lucy Short, and a speech and language team lead Emma Freeman. Nursing care is provided by a team of rehabilitation nurses led by ward manager Dawn Ellison, stroke clinical nurse specialist Donna Berry and ward sisters Agie Dobrogowska, Jenny Fisher and Sharon Levi. Social workers also form part of the team along with Dr Donnchadh Murphy, the ward clinical psychologist and Yvonne Mitchell, the ward dietician.
Donna explains: “Stroke can have a huge impact on every aspect of a person’s life, especially mood. Stroke is a spontaneous event so people need time to adjust and also grieve. For many people stroke can lead to loss of independence and adjusting to a new disability.
“When they come here we can start to have deeper discussions about their condition. We aim within the first 5 days of admission to offer a goal setting meeting where we try to establish what goals people want to achieve – their goal might be walking or going home for example, and we then break that down into smaller goals. At the same meeting we use an outcome measure tool called FIM+FAM which looks at the dependency of a person and can give you an idea of how many days of rehabilitation they might need. It is just a guide, so we also use our clinical judgement and knowledge of other comorbidities to provide an estimated date of discharge.
“On a Monday to Friday basis, patients are then provided with a timetable of their planned therapies for that day so that they and their relatives know what’s ahead. We work to the Royal College of Physician stroke guidelines which make recommendations regarding what stroke rehabilitation should consist of, including intensity of therapy.
“The ambition is for seven day working for therapies, however it is currently provided over 6 days when fully staffed. Nursing is provided at all times and we try to embed a rehab culture over the 24 hour period where nursing staff continue to practice with transfers, upper limb care, self-medication assessments and other rehabilitation goals.”
Around a week after the goal setting meeting, the patient and their family, carer or advocate are then invited to a progress meeting that is attended by the MDT.
Donna said: “Individual members of the MDT provide feedback from their professional assessments and we’re able to build up a picture of how that person is progressing. The team are then in a position to discuss progress with recovery and plans for leaving hospital.”
For many people they are discharged home with or without a package of care – some may also have ongoing stroke targeted therapy provided by the Stroke Early Supported Discharge team – while others are discharged to care homes.
Donna said; “There are challenges with delays to packages of care and there is no obvious pattern to incidence of stroke, so the need for rehab beds does fluctuate. The current plan is to increase the stroke rehab bed base to 20 which would also help ease flow through the acute hospital and allow quicker access to rehabilitation.”
The team and their patients are also supported by volunteers; people who have lived experience of stroke either through experiencing it themselves, caring for a loved one, or having worked previously within stroke services. Monthly stroke cafes are also held on the ward, these are led by the Stroke Association and attended by current and ex stroke service users. The café provides opportunity to talk and share experiences associated to stroke.
The team are also heavily involved in educating the public on the prevention of stroke, holding events in places like Drake Circus shopping centre and the Life Centre where members of the public can have their blood pressure and pulse checked, receive advice on how to minimise their lifestyle risk factors, and be signposted to their GP if necessary for further help. Over 170 people took advantage of the offer at Drake Circus recently, and the team are keen to spread their message even further.
Donna said: “I love taking our message out into the community. Prevention of stroke is so important, as is dispelling some of the myths that stroke only happens to older people. Everybody in the team is absolutely passionate about what we do, and we’re really keen to keep delivering and improving our service.
“It’s the best feeling for the team to see someone who has transferred from the acute hospital with marked impairments to then leave SRU in a much better place. It makes me feel incredibly proud to know that our team effort has contributed to their recovery.”