ACUTE STROKE INTEGRATED CARE PATHWAY

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ACUTE STROKE INTEGRATED CARE PATHWAY

ALL OTHER DISCIPLINES

The Pathway must be retained in the patient’s notes

and any additional documentation must

be attached behind this document.

This pathway is intended for guidance only.

It is no way intended to be prescriptive.

Clinical decisions remain at the discretion of the clinician.

PATIENT NAME ____________________________________

H&C NUMBER ____________________________________

DATE OF BIRTH ____________________________________

CONSULTANT ____________________________________

REMEMBER TO:

 Complete each section clearly and in full

 Tick boxes where appropriate

 Countersign each section



If ‘No’ is ticked record variance

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DATE

DAY

DAY 1

DAY 2

DAY 3

DAY 4

DAY 5

DAY 6

DAY 7

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If patient is receiving Thrombolysis treatment complete section A below, and pages 4-13 of care pathway.

Tick  as you deliver care, if ‘NO’ is ticked document reason in variation record on page 11.

Section A.

Patient attached to cardiac monitor: Yes  No 

Abnormal arrhythmias observed in 1st 24 hours; Yes  N/A  If Yes reported to Dr and recorded in evaluation Yes  N/A  Time 1st syringe of Actilyse infused ………

Time 2nd syringe of Actilyse infused……… N/A 

On completion of Actilyse, giving set flushed with 20mls normal saline over 30 seconds: Yes  No 

GCS / MEWS observations recorded every 15mins from commencement of infusion for 3 hours: Yes  No 

Then every 30 mins for 6 hours: Yes  No  Then hourly for 15 hours: Yes  No 

Observe for the following potential complications while recording GCS and MEWS observations, during ACTILYSE administration.

GCS score dropped by 2 or more (from baseline GCS) Blood pressure reading > 230/120 mm Hg

2 Blood pressure readings taken 5 minutes apart > 185/110 mm Hg

(if BP reading is > 185/110, repeat 5 minutes later. If BP remains > 185/110 stop infusion) Signs / Symptoms of anaphylaxis

(angioedema, hypotension, bronchospasm, uticaria, itch) Signs / Symptoms of intracerebral haemorrhage (headache, vomiting, seizures, hypertension)

Signs / Symptoms of systemic haemorrhage

(hypotension, tachycardia, clammy, sweating, haematuria, haemoptysis, abdominal distension etc)

If any of the above occurs during administration stop infusion and inform Dr immediately.

Repeat C.T imaging of brain ordered for 24 hours from completion of Actilyse infusion: Yes  No 

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PATIENT DETAILS / NURSING STAFF TO COMPLETE

Name:...…………Known as: ...……….……… Address……….

Tel No.: ………..… DOB: ……… Age: ………. Religion: ...

Occupation: ………...……

Married  Single  Widowed  Divorced  Retired  Employed  Unemployed 

First language ………Interpreter required? Yes  N/A 

Date of Symptom onset: .…………... Time of onset : ………...…... Date / Time of admission to ward: ... Property book: Yes  N/A  In safe: Yes  N/A 

Identity bracelet: Yes  No 

Allergies: Yes  N/A 

If yes please specify: ______________________________________________________

Presenting reason for admission:

...………...………... ...………...…………...

Baseline Observations

BP right arm lying ___________ BP left arm lying

___________

Pulse __________ GCS __________ Temp. _________ Record Blood Glucose --- Oxygen Saturation Level______________ If below 95% Doctor informed Yes  No  Urinalysis Result ___________________________________________________________ MSU/CSU obtained: Yes  N/A



Results of CT Scan of brain:

...………...………... Infection control status on admission……….. Date/Sign/Designation: ………. Next of Kin/Contact Person

Name: ...………….………... Relationship: ………. Address: ...………... Tel No: Day ………

………. Tel No: Night ……….

Additional contact………..

GP: ……… Tel No: ……….

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REFERRALS TO ALL OTHER DISCIPLINES

Following receipt of referral patients must be assessed by clinical

Professions within the timeframe specified by

their professional guidelines

**Swallow screening may also be performed by nursing staff trained in Regional Swallow Screen Date of referral Sign. Date Referral Received Sign. Date of assessment Sign. Physiotherapy

Speech & Language Therapist: Swallow ** Speech Language Dietician Social Worker OT Stroke Nurse Specialist

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Record of Investigations and Referrals

Date Investigations/

referrals

Sign/Desig Date Investigations/ Referrals

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On Admission /First 24 hours/ Nursing staff to complete

Usual condition Pre-Stroke

Changes due to present condition Prescribed Nursing Interventions Level of Consciousness Level of Consciousness

Drowsy  Semi-conscious 

(responds to speech fully) (not fully rousable)

Conscious  Unconscious 

GCS / MEWS observations commenced: Yes  No  Frequency……….. ……… OR

as per Thrombolysis guidelines: Yes 

If GCS < 8 Dr informed: Yes  N/A 

BM recorded: Yes  No 

Breathing

Colour: ………... Breathless:

Lying Yes  N/A  Sitting Yes  N/A  On exertion Yes  N/A  Smokes: Yes  N/A  ……… per day

Home 02: Yes  N/A 

Breathing

Colour: ……….. Breathless:

Lying Yes  N/A  Sitting Yes  N/A  On exertion Yes  N/A  Mobility Dependent  Transfers with 2  Transfers with 1  Walks with 2  Walks with 1  Independent  Appliances / prosthesis / Equipment , Specify : ………. ……… Mobility Bed rest  Transfers with 2  Transfers with 1  Walks with 2  Walks with 1  Independent 

Appliances / prosthesis / equipment

Specify: ………. ………. Manual handling risk assessment form completed: Yes  No 

Referred to physiotherapy: Yes  No 

Circulation Circulatory problems: Yes  N/A  Please state……… Circulation

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Date/Signature/ Designation………. Usual condition Pre-Stroke Changes due to present condition Prescribed Nursing Interventions Cleansing and Dressing

Independent 

Assistance required, specify below: 1 Person 2 Persons Upper body washing   Upper body dressing   Lower body washing   Lower body dressing  

Dentures: Top  Bottom 

Cleansing and Dressing

Independent 

Assistance required , please specify below: 1 Person 2 Persons Upper body washing   Upper body dressing   Lower body washing   Lower body dressing  

Dentures: Top  Bottom 

Oral hygiene assessed Yes  N/A  State mouth care frequency: …………..……

Eye Care: Yes  N/A 

(Refer to Royal Marsden procedure manual for eye care / mouthcare)

Referred to O.T: Yes  No 

Skin Condition (on admission)

Pressure ulcers: Yes N/A Other Skin Condition

Specify……….. ………

Skin Condition

Braden Tool completed: Yes  No  Pressure ulcer prevention pathway / wound

assessment completed Yes  N/A  Pressure mattress: Yes N/A 

if yes state type of mattress:

………. Pressure cushion Yes  N/A  Repositioning guidelines Yes  N/A 

Communicating

Visually Impaired Yes  N/A  Aids used:

……… Hearing impaired Yes  N/A  Aids used:

………

……… ….

Speech difficulty Yes  N/A  Specify: ………..…

Communicating

Visually Impaired Yes  N/A 

Aids used: ……….……….. ……… Hemianopia Yes  N/A 

Left  Right: 

Speech Affected Yes  N/A  Specify: ……….

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Date/Signature/ Designation………. Usual condition

Pre-Stroke

Changes due to present condition Prescribed Nursing Interventions Eliminating

Continent Urine Yes  Incontinent of urine Yes  Continent faeces Yes 

Incontinent of faeces Yes  If incontinent describe nature of problem and management:

………. ……….

Needs assistance toileting Yes  Specify assistance needed:

………. Catheter insitu Yes 

Date last renewed………. Reason for insertion……….

Eliminating

Continent Urine Yes  Incontinent of urine Yes  Continent faeces Yes 

Incontinent of faeces Yes 

If incontinent, continence assessment / care plan commenced:

Yes  No 

Catheter inserted Yes  N/A  Reason for insertion

………..

(Refer to Royal Marsden Procedure Manuel for catheter care)

If patient is receiving Thrombolysis avoid insertion of catheter for 1st 24 hours from commencement of infusion

Eating and Drinking

Special diet Yes 

Specify: ……… Can prepare meals Yes 

Assistance feeding Yes 

If yes specify: ………

Eating and drinking

Referred to SALT: Yes  No Swallow screen performed: Yes  No Nil by mouth Yes  No N/A 

All patients that receive Thrombolysis should fast for 24 hours from commencement of infusion

Must completed: Yes  No

Special diet: Yes  No N/A  Specify: ……….

Normal diet and fluids : Yes  No Assistance feeding Yes  No N/A 

If yes specify: ……… I.V. fluids in progress Yes  No

I.V. cannula in situ: Yes  No

I.V. cannulation chart commenced: Yes  No Fluid Balance Chart: Yes  No

All patients that receive Thrombolysis must avoid insertion of additional cannulas for 1st 24 hours from commencement of infusion

Mental Health

Short term memory loss Yes  History of Depressive illness Yes  Aggression verbal/physical Yes  Attends psychiatric clinic Yes 

Mental Health

Oriented Yes  Aggression verbal/physical Yes  Agitated Yes 

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Please complete if patient is in receipt of:

Social Assessment

House  Steps inside  steps outside  Bungalow/Downstairs flat  Bathroom upstairs  downstairs  Upstairs flat  Toilet upstairs  downstairs  Sheltered housing  Ramps 

Residential Home  Stair lift  (Permanent / temporary) 

Nursing home 

(permanent / temporary)  Pets: 

Support from family carer:  ………. Living: Alone  Main carer name:_________________________ With partner 

Dependents  Address:________________________________ With other family  _______________________________________ Telephone number_______________________

Referred to social worker: Yes  No  N/A 

Date/Signature/ Designation……….

M T W T F S S Comments

Home care support worker (personal care)

Record number of carers

Home care (practical care) Meals on wheels

Day Centre Name Centre

Day Hospital General Day Hospital Psychiatric

District Nurse Reason for visits

Community Psychiatric Nurse

Respite Frequency

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Nursing Summary Sheet

________________________________________________________________________________________

Previous Medical History

________________________________________________________________________________________

Current Medication _______________________________________________________________________

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DAY ONE

Resus Status: ______________________________ Infection control precautions: Yes N/A

Date/Time Care progress/Evaluation Signature

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DAY ONE

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PATIENT MANUAL HANDLING RISK ASSESSMENT (Hospital)

Physical Disability: Handling Constraints/Behaviour

Previous Mobility:

History of Falls: YES/NO Weight, BMI & Height:

Patient independent for all activities YES/NO No further assessment required YES/NO Further assessment required post op: YES/NO Name & Destination: ______________________ (Please print) ____________________________ Signature: _________ _____________________ Date: ______________________________

DATE DATE DATE

Dependence Aid Hoist & Sling Dependence Aid Hoist & Sling Dependence Aid Hoist & Sling Bed/Trolley to Bed Up/down bed Turning in bed Lying to sitting Bed/Chair to Chair/commode Walking Showering/ Bath Other

Print Name & Designation:

Any other comments / instructions

Dependence Independent 0 Supervision S Assistance of 1 1 Assistance of 2 2 Assistance of 3 3 More than 3 state no.

Handling Aid

Flat slide sheets FS Roller slide sheets RS Handling Belt HB Transfer board TB Stand Aid SA Other Zimmer Z Rollator R Crutches C Walking Stick WS Bed profile BP Hoist Mobile Hoist MH Overhead hoist OH Standing hoist SH Bariatric Hoist BH Sling size/type Small S Medium M Large L Extra Large XL Standard St Toileting T Disposable D Other

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PATIENT MANUAL HANDLING RISK ASSESSMENT - Continuation Sheet

DATE DATE DATE

Dependence Aid Hoist & Sling Dependence Aid Hoist & Sling Dependence Aid Hoist & Sling Bed/Trolley to Bed Up/down bed Turning in bed Lying to sitting Bed/Chair to Chair/commode Walking Showering/Bath Other

Print Name & Designation:

Any other comments / instructions

Dependence Independent 0 Supervision S Assistance of 1 1 Assistance of 2 2 Assistance of 3 3 More than 3 state no.

Handling Aid

Flat slide sheets FS Roller slide sheets RS Handling Belt HB Transfer board TB Stand Aid SA Other Zimmer Z Rollator R Crutches C Walking Stick WS Bed profile BP Hoist Mobile Hoist MH Overhead hoist OH Standing hoist SH Bariatric Hoist BH Sling size/type Small S Medium M Large L Extra Large XL Standard St Toileting T Disposable D Other

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BRADEN SCALE – For Predicting Pressure Ulcer Risk

(Initial assessment to be completed within 2 hours of admission) AT RISK: 18 OR LESS > Commence Pressure Ulcer Prevention Pathway

LOW RISK: 19 – 23 DATE OF ASSESS SCORE/DESCRIPTION 1 2 3 4 RISK FACTOR SENSORY PERCEPTION Ability to response meaningfully to pressure related discomfort 1.COMPLETELY LIMITED Unresponsive (does not moan, flinch or grasp) to painul stimuli, due to diminished level of sedation. OR Limited ability to feel pain over most of body surface. 2.VERY LIMITED Repsonds only to Painful stimuli. Cannot communicate discomfort except by moaning or restlessness. OR

Has a sensory Impairment which limits the abilty to feel pain or

discomfort over ½ of body.

3. SLIGHTLY LIMITED

Reponds only to verbal commands, but cannot always communicate discomfort or need to be turned

OR

Has some sensory impairment which limits ability to feel pain or discomfort in 1 or 2 extremities. 4. NO IMPAIRMENT Responds to verbal commands. Has no sensory deficit which would limit ability to feel or voice pain or discomfort.

MOISTURE

Degree to which skin is exposed to moisture.

1. CONSTANTLY MOIST

Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned.

2. VERY MOIST

Skin is often, but not Always

moist. Linen must be changed at least once a shift.

3. OCCASSIONALLY MOIST

Skin is occasionally moist, requiring an extra linen change approximately once a day.

4.RARELY MOIST

Skin is usually dry, linen only requires changing at routine intervals. ACTIVITY Degree of physical activity. 1. BEDFAST Confined to bed. 2. CHAIRFAST

Ability to walk, severely limited or non-existent. cannot bear own weight and/or must be assisted into chair or wheelchair.

3. WALKS OCCASIONALLY

Walks occasionally during day, but for very short distances, with or without assistance.

Spends the majority of each shift in bed or chair.

4. WALKS FREQUENTLY

Walks outside the room at least twice a day and inside room at least once every 2 hours during walking hours.

MOBILITY

Ability to change and control body position.

1. COMPLETELY IMMOBILE

Does not make even slight changes in body or extremity position without assistance.

2. VERY LIMITED

Makes occasional slight changes in body or extremity position but unable to make frequent or significant changes independently.

3. SLIGHTLY LIMITED

Makes frequent though slight change in body or extremity position independently.

4. NO LIMITATIONS

Makes major and frequent changes in position without assistance.

NUTRITION

Usual food intake pattern 1 NPO: Nothing by Mouth. 2 IV: Intravenously 3 TPN: Total Parenteral nutrition. 1. VERY POOR

Never eats a complete meal. rarely eats more that 1/3 of any food offered.

eats two servings or less of protein (meat or dairy products) per day. Takes fluids poorly. does not take a liquid dietary supplement

OR

Is NPO1 and/or maintained on clear fluids or IV2 for more than five days.

2. PROBABLY INADEQUATE

Rarely eats a complete meal and generally eats only about ½ of any food offered. Protein intake includes only 3 servings of meat or dairy products a day. Occasionally will take a dietary supplement. OR

Receives less than optimum amount of liquid diet or tube feeding.

3. ADEQUATE

Eats over ½ of most meals. Eats a total of 4 servings of protein (meat dairy products) each day. Occasionally will refuse a supplement if offered.

OR

Is on a tube feeding or TPN3 regime which probably meets most of nutritional needs.

4. EXCELLENT

Eats most of every meal. Never refuses a meal. Usually eats a total of 4 or more servings of meat or dairy products. Occasionally eats between meals. does not require supplementation.

FRICTION & SHEAR 1. PROBLEM

Requires moderate to maximum assistance in moving. complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance. Spasticity contractures or agitation leads to almost constant friction.

2. POTENTIAL PROBLEM

Moves feebly or requires minimum assistance. during a move skin Ppobably slides to some extent against sheets, chair restraints or other devices. Maintains relatively good position in chair or bed most of the time but occasionally slides down.

3. NO APPARENT PROBLEM

Moves in bed and in chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair at all times.

TOTAL SCORE

ASSESS DATE TIME SIGNATURE OF REGISTERED NURSE ASSESS DATE TIME SIGNATURE OF REGISTERED NURSE

1 3

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MUST DOCUMENTATION

COMPLETE ON ADMISSION

:

Height……….m Actual

□

or Recalled

□

Weight………kg Actual

□

or Recalled

□

PRE-MUST QUESTIONS: Does the patient have :-

DATE

1 . A history of recent weight loss Yes / No Yes / No Yes / No 2. Altered/decreased appetite for 7 days

or more

Yes / No Yes / No Yes / No 3. A risk of under nutrition due to current

illness

e.g. difficulty eating/drinking

Yes /No Yes / No Yes / No

4 A need for assistance with feeding Yes / No Yes / No Yes / No SIGNATURE

If answer is No to all of the above questions repeat screening weekly.

If answer is yes to any of the above questions then complete ‘Must’ below. Also repeat weekly.

Date

Weight (Kg) / MUAC (cm) Height (m) / Ulna length (cm) BMI

Score Score Score STEP 1 BODY MASS INDEX-BMI

Over 20 0 0 0

18.5 to 20 1 1 1

Less than 18.5 2 2 2

STEP 2 UNPLANNED WEIGHT LOSS IN LAST 3-6 MONTHS

Less than 5% 0 0 0

Between 5-10% 1 1 1

More than 10% 2 2 2

STEP 3 ACUTE DISEASE

If patient is acutely ill AND there has been

OR is likely to be no nutritional intake for more than 5 days

2 2 2

TOTAL MUST SCORE:

Low Risk =0 Medium Risk =1 High Risk 2

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Malnutrition Universal Screening Tool (MUST) Flowchart LOW RISK MUST score = 0 MEDIUM RISK MUST score = 1 HIGH RISK MUST score = > 2  Record MUST Details  Recommend a WELL BALANCED DIET  Record MUST Details  Recommend High Protein / Energy Diet

 Monitor intake for 3 days (record on food

chart )

 Record MUST Recordings

 Refer to Dietitian

 Recommend High Protein /Energy Diet

 Monitor intake as per Dietitian (record on

food chart)

RESCREEN

Weekly

RESCREEN

1 week and refer to dietitian if risk status changes

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DAY 2

Tick  as you deliver care, if ‘NO’ is ticked record why in variation record.

Unless stated otherwise activities below to be completed by Nurse Conscious Yes  Unconscious Yes 

GCS observations recorded Yes  No  Frequency: ………. (Refer to Royal Marsden)

Mews continued: Yes  No Frequency………. BM recorded: Yes  No N/A 

Hydration

IV fluids in progress: : Yes  No  N/A  Subcutaneous fluids in progress : Yes  N/A 

Fluid Balance Chart Recorded: Yes  No  N/A  I.V. cannula in situ Yes  N/A 

If cannula in situ, I.V. cannulation chart reviewed Yes  No 

Nutrition:

Nil by mouth  Normal diet 

Modified Consistency (MC)  Specify_____________________ Thickened Fluids (TF)  PEG  NG 

If MC or TF referred to Dietician: Yes  No

Food Chart : Yes  No N/A 

Mobility:

Manual handling risk assessment form reviewed : Yes  N/A  Bed Rest  Up to sit 

Transfer with hoist 

Transfers with 1  Transfers with 2  Mobile with 1  Mobile with 2 

Mobile with aid  Mobile with supervision  Independent 

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DAY 2

Tick  as you deliver care, if ‘NO’ is ticked record why in variation record.

Cleansing and Dressing:

Personal Hygiene Independent 

1 Person 2 Persons Assistance required: Lower Half   Upper Half   Bed bath   Shower   Dressing Independent  1 Person 2 Persons Assistance required: Lower Half  

Upper Half  

Eye Care: Yes  No N/A 

Mouth Care: Yes  No N/A  (Refer to Royal Marsden)

Skin Condition

Pressure Mattress Yes  No N/A  If yes specify type: ………

Pressure Relieving Cushion Yes  No N/A  If yes specify type: ………

Wound assessment chart reviewed Yes  No N/A 

Elimination:

Continent Urine: Yes  Incontinent of urine: Yes  Continent faeces: Yes  Incontinent of faeces: Yes 

If incontinent, continence assessment continued / care plan reviewed Yes  No SRC in situ Yes  N/A 

If SRC in situ, catheter care performed Yes  No (refer to Royal Marsden)

Bowels opened Yes  N/A 

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DAY 2

Tick  as you deliver care, if ‘NO’ is ticked record why in variation record. Pain Intervention:

Has patient pain as per MEWS chart: Yes  N/A 

If yes details recorded in evaluation. Yes  No 

Barriers to communication:

Sleep pattern documented in evaluation: Yes  No 

(record duration of sleep, number of times awakened, why patient awakened etc)

Patient’s condition and pathway discussed with patient/family/carer: Yes  No  Details of conversation recorded in evaluation: Yes  No 

Physio to complete: Positioning:……… Transfers:……….. Mobility / Gait:………..

S&L Therapist to complete:

Swallow assessment :  Yes  No  N/A

Communication assessment:  Yes  No  N/A

O.T. to complete:

Assessment and treatment commenced / continued:  Yes  No  N/A

State variance

Reason (if known) Date

Signature

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DAY 2

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DAY 2

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DAY 3

Unless stated otherwise activities below to be completed by Nurse

Conscious Yes  Unconscious Yes 

GCS observations recorded Yes  No N/A  Frequency: ……… (Refer to Royal Marsden)

Mews continued: Yes  No N/A  Frequency………. BM recorded: Yes  No N/A 

Hydration

IV Therapy in progress: : Yes  N/A  Subcutaneous fluids in progress: Yes  N/A 

If cannula in situ, I.V. cannulation chart reviewed Yes  No

Nutrition:

Mobility:

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DAY 3

Cleansing and Dressing:

1 Person 2 People Assistance required: Lower Half   Upper Half   Bed bath   Shower   Dressing Independent  1 Person 2 Persons Assistance required: Lower Half  

Upper Half  

Eye Care Yes  No N/A 

Mouth Care Yes  No N/A  (Refer to Royal Marsden)

Skin Condition

Wound assessment chart reviewed Yes  No N/A  Elimination:

If incontinent, continence assessment continued / care plan reviewed Yes  No  SRC in situ Yes  N/A 

If SRC in situ, catheter care performed Yes  No  (refer to Royal Marsden)

Bowels opened today: Yes  Bowels opened in last 2 days: Yes  Bowels not opened in 3 days Yes  If Yes, Dr informed Yes  No

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DAY 3

Pain Intervention:

If yes details recorded in evaluation. Yes  No 

Sleep pattern documented in evaluation: Yes  No

Physiotherapist to complete: Positioning:……… Transfers:……….. Mobility /Gait: ………..

Swallow assessment : Yes  No N/A 

Communication assessment: Yes  No N/A 

OT to complete:

Assessment and treatment continued: Yes  No N/A 

State variance

Reason (if known)

Date

Signature

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DAY 3

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DAY 3

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DAY 4

GCS observations recorded Yes  N/A  Frequency: ……… (Refer to Royal Marsden)

Hydration

IV Therapy in progress: Yes  N/A  Subcutaneous fluids in progress: Yes  N/A  Fluid Balance Chart Recorded: Yes  N/A  I.V. cannula in situ Yes  N/A 

Nutrition:

Mobility:

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DAY 4

Cleansing and Dressing:

Upper Half  

Skin Condition

Wound assessment chart reviewed Yes  No N/A  Elimination:

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DAY 4

Has patient pain as per MEWS chart: Yes  N/A  If yes details documented in evaluation. Yes  No 

Physio to complete: Positioning:……… Transfers:……….. Mobility /Gait: ………..

OT to complete:

State variance

Reason (if known)

Date

Signature

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DAY 4

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DAY 4

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DAY 5

Hydration

IV Therapy in progress: Yes  No  N/A  Subcutaneous fluids in progress: Yes  N/A 

Nutrition:

Mobility:

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DAY 5

Cleansing and Dressing:

Upper Half  

Skin Condition

Wound assessment chart reviewed: Yes  No N/A  Elimination:

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DAY 5

If yes details documented in evaluation: Yes  No 

Physiothearapist to complete: Positioning:………. Transfers:……… Mobility/ Gait:……….

OT to complete:

State variance

Reason (if known)

Date

Signature

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DAY 5

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DAY 5

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DAY 6

Hydration

IV Therapy in progress: Yes  N/A 

Subcutaneous fluids in progress: Yes  No  N/A  Fluid Balance Chart Recorded: Yes  N/A  I.V. cannula in situ Yes  N/A 

Nutrition:

Mobility:

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DAY 6

Cleansing and Dressing:

Upper Half  

Skin Condition

If incontinent, continence assessment continued /care plan reviewed Yes  No SRC in situ: Yes  N/A 

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DAY 6

Has patient pain as per MEWS chart: Yes  N/A  If yes document details in evaluation.

(record duration of sleep, number of times awakened, why patient awakened etc)

Physio to complete: Positioning:………. Transfers:……… Mobility/Gait:………..

Swallow assessment : Yes  No N/A  Communication assessment: : Yes  No N/A 

OT to complete:

State variance Reason (if known)

Date

Signature

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DAY 6

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DAY 6

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DAY 7

Hydration

IV Therapy in progress: Yes  No  N/A  Subcutaneous fluids in progress: Yes  N/A 

Nutrition:

Mobility:

(45)

DAY 7

Cleansing and Dressing:

Upper Half  

Skin Condition

Pressure Relieving Cushion: Yes  No N/A  If yes specify type: ………

If incontinent, continence assessment continued / care plan commenced Yes  No SRC in situ: Yes  N/A 

Bowels opened Yes 

Bowels opened today: Yes  Bowels opened in last 2 days: Yes  Bowels not opened in 3 days Yes  If Yes Dr informed Yes  No

(46)

DAY 7

If yes details documented evaluation. Yes  No 

Physio to complete: Positioning:……… Transfers:……….. Mobility/Gait:……….

Swallow assessment : ……… Communication assessment: ……….

OT to complete:

State variance

Reason (if known)

Date

Signature

(47)

DAY 7

(48)

DAY 7

(49)

DISCHARGE PLAN

Date Signature/

Designation Estimated date of discharge

(to be completed within 24 hours of admission)

Discharge arrangements confirmed with patient / carer Yes  N/A  ________________________________________________________ ________________________________________________________ Record carers name:

Mode of transport (e.g ambulance, relative)

Time Ambulance booked:……… Booking number:………. Target time:………..

If ambulance is delayed Bed / Site Manager informed Yes  GP letter given and explained to patient / carer Yes  Medications given and explained to patient / carer Yes 

Patients own medication returned to patient / carer Yes N/A Patient has received written information re: discharge medications Yes 

Patient property returned Yes  N/A 

(record to whom this was given)

Out patient appointment given Yes  N/A 

(record to whom appointment given)

Discharge advice given including point of contact should complications arise following discharge Yes 

Tracker form completed Yes  N/A  Ward returns book completed Yes  Cannula removed Yes  N/A  Referred to District Nurse Yes  N/A 

(Record reason eg. Continence management, wound management, Equipment etc)

Patient for discharge to

Own Home  Residential Home  Nursing Home  Relatives Home 

If discharge address is different to patients home address record new address:

Discharge Nurse: Time of discharge: Discharge Code:

Transfer of Patient to a Nursing Home or other Hospital

Transferred to:

Patient / Relative/ Carer informed  Name: Staff informed of transfer  Name:

(50)

DISCHARGE PLAN

Speech and Language Therapist to complete

Date/ Sig

Communication/swallow advice to patient, carer Yes  N/A  Addition of thickener to discharge medication list Yes  N/A  SALT follow up required Yes  N/A 

Referred to Specialist Community Stroke Team: Yes  No  N/A 

Physiotherapist to complete

Occupational Therapist to complete

Social Worker to complete Services to be installed upon discharge: Date services to

be commenced

Date / Sign

State variance

Reason (if known)

Date

Signature

EQUIPMENT Date Ordered Signature Date delivered/Collected Signature

Walking stick Zimmer frame / Rollator

Other

Mobility upon discharge:

Independent  Zimmer frame/rollator  With supervision  Uses wheelchair  Walking stick  Chair bound  Has patient had a stair assessment Yes  N/A 

Referred to Specialist Community Stroke Team: Yes  No N/A 

Date / Signature

Are equipment needs met for discharge Yes  N/A  OT Home / Access Visit completed Yes  N/A 

OT discharge summary enclosed Yes  N/A  Home exercise programme Yes  N/A 

(51)

WEEKLY WARD MD TEAM MEETING

Date Week Evaluation Goals Signature/

(52)

WEEKLY WARD MD TEAM MEETING

(53)

WEEKLY WARD MD TEAM MEETING

(54)