Disclaimer
This process was developed for Penrose Health, and is based on NICE guidelines from April 2023. You must have the appropriate training, use your clinical judgement, and escalate when necessary.
Why we do this review
A stroke & TIA review identifies patients with ischaemic stroke or a history of TIA, to optimise their treatment such that we can prevent another stroke from occurring.
Summary
A stroke is when the blood supply to part of the brain gets cut off, killing brain cells. There are three types of stroke:
- Ischaemic stroke: when a blood vessel gets blocked and cuts off blood supply to the brain
- Haemorrhagic stroke: when a blood vessel supplying the brain bursts, causing bleeding in or around the brain
- Transient ischaemic attack (TIA) (a.k.a. a mini-stroke): when a blood vessel gets temporarily blocked, cutting off blood supply to the brain for a short period of time
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Care pathways
Part of QOF and South East London CCG Premium Specification
This pathway is designed to identify patients with ischaemic stroke or a history of TIA, in order to optimise their treatment such that we can prevent another stroke from occurring.
1️⃣ Book the appointment
Reception
- We are using a combination of platforms / tools / teams to book patients in correctly with minimal manual effort. If @Louis Williams hasn’t already been in touch, check out the page to find our Monthly Summary plans or reach out to him to find out what you should be doing:
- If we’re using Hippo Labs, log into app.hippolabs.co.uk to find patient lists (see for more information)
- If we’re using Hero Health or AccuRX, @Louis Williams will send your team manual excel recall lists
- Call the patient to book an appointment with an HCA (for housebound patients, the review can be performed by a Care Coordinator if appropriate)
Explain what the appointment is for, advise them that they’ll have a blood test on the day
Always check if the patient requires an interpreter (book double appointment if they do), if there’s anything else pending in the pink QOF box that we can address while we’re speaking with the patient, and that their contact details are correct
2️⃣ Patient arrives for appointment
Reception
- Record that the patient has arrived in the appointment book
- Allow the patient a moment to relax before asking to capture data on height, weight, blood pressure, smoking status, and alcohol status (if possible) and add to patient’s EMIS record
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3️⃣ Carry out review
HCA (F2F) or Care Coordinator home visit if housebound
- Open the clinical template: ‘Penrose Health - Stroke & TIA’ on EMIS
- Draw bloods (for HbA1c, LFT, FBC, cholesterol & renal function test)
- Take Blood Pressure Readings and complete the template, capturing data on any parameters missed by reception
- Refer for smoking cessation if appropriate
- Offer seasonal flu vaccine and pneumococcal vaccine if required/eligible
- Task reception to book the patient a medication review with a Pharmacist
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For housebound patients, the review can be performed by a Care Coordinator if appropriate. If necessary, Care Coordinators can refer the patient to a district nurse for bloods.
Tell the patient that they’ll be contacted with their test results. Alternatively, patients can check results themselves via Patient Access & the NHS App
3️⃣ Check and triage results
Lab Reports Team
- Review pathology results, and action as per the Lab Reports (Path Links) page. If, according to this page, a follow-up appointment is required, progress to step four below.
4️⃣Medication Review
Pharmacist (F2F or remote)
- Open the clinical template: ‘Penrose Health - Stroke & TIA’ on EMIS
- Check that the patient is on a statin or other lipid-lowering therapy
- If not, initiate medication
- If they are but QRISK2 is out of range, review dosage
- Complete the ‘Pharmacist Review’ page of the template
- Please check QOF rule STIA007 regarding prescription of anti-coagulants and anti-platelet medication to relevant patients
STIA007 advises that anti-platelet therapy is prescribed for the secondary prevention of recurrent stroke and other vascular events in patients who have had a stroke or TIA. Patients with stroke associated with Atrial Fibrillation (AF) should be reviewed for long-term treatment with an anti-coagulant.
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Resources for patient info/referral
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