1. Stroke Education An Evidenced Based Approach Presented by Elaine Siwiec, RN, BSN April 8, 2010

2. 2 Stroke Education New York, March 5, 2009 The number of patients who do The number of patients who do not take secondary prevention not take secondary prevention measures after having a stroke is measures after having a stroke is “alarmingly high” “alarmingly high” Source: Ross J, Stroke 2009,10: 1161

3. 3 Importance of Recurrent Stroke Makes up about 25% of all strokes Recurrence rates as high as ~ 30% over 5 years Associated with substantial costs to the health care system Application of proper prevention interventions provides an opportunity to prevent subsequent stroke Source: Roberts CS, Gorelick, Stroke 2009, 40: 1425-1432

4. 4 Stroke Education Required by the Joint Commission Personal risk factors for stroke Personal risk factors for strokePersonal risk factors for strokePersonal risk factors for stroke Stroke Warning Signs Stroke Warning SignsStroke Warning SignsStroke Warning Signs Activation of EMS Activation of EMSActivation of EMSActivation of EMS Need for follow-up after discharge Need for follow-up after dischargeNeed for follow-up after dischargeNeed for follow-up after discharge New medications prescribed at discharge New medications prescribed at dischargeNew medications prescribed at dischargeNew medications prescribed at discharge

5. 5 Stroke Education

6. 6 Disease Specific Patient Satisfaction Survey This was our first attempt to measure the effectiveness of our education Two Questions Related to Stroke Education I can name my personal risk factors of stroke I understand what I can do to reduce the risk of another stroke

7. 7 Prevention Strategies PROTECT – Preventing Recurrence of Thromboembolic Events through Coordinated Treatment 8 medication/behavioral secondary prevention measures Objective was to determine utilization rates at 90 days after discharge Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883

8. 8 Definition of Adherence for Each Behavioral Goal (PROTECT) Smoking Cessation – no smoking activity beyond 1 month Exercise – moderate exercise defined by walking, running or swimming for 30 minutes at least 4 days per week or PT or OT of a similar duration and frequency. Diet – 5 servings of fruits and/or vegetables per day, at least 2 servings of fish per week and at least 1 fiber-rich meal per day for 4 of 7 days per week. Stroke Awareness – 911 awareness, able to name at least 2 of their modifiable risk factors and aware of at least 3 of 5 common stroke warning signs Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883

9. 9 PROTECT RESULTS Sept 2002 to Aug 2003 130 patients – results at 90 day follow-up Antithrombotics = 100% Statins = 99% Importance of Calling 911 = 87% Adherence to Diet = 78% Adherence to Exercise = 70% Tobacco Cessation = 83% Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883

10. 10 PROTECT TOOLS Bedside teaching Patient self monitoring log Information brochures Handoff letters to primary physicians Telephone interview abstraction form Report score card Source: Ovbiagele B, Saver J L, Stroke 2004, 35: 2879-2883

11. 11 Successful Strategies to Reduce Stroke Risk Studied the effect of simple advice vs. brief educational intervention Brief Intervention (BI) model integrates motivational interviewing with behavioral change Source: Miller E T, Spilker J, Journal of Neuroscience Nursing, Aug 2003, 35: 215-222

12. 12 Six Key Ingredients Trigger Motivation to Change (FRAMES) Feedback: Patient receives info on current status Responsibility: Patient assumes responsibility for the change change Advice: Patient receives suggestions to help in the change process change process Menu: Patient receives a number of alternative strategies for modifying the problem behavior strategies for modifying the problem behavior Empathy – Patient receives warm support and respect Self-efficacy: Patient develops an “I can do this!” attitude attitude Source: Miller E T, Spilker J, Journal of Neuroscience Nursing, Aug 2003, 35: 216

13. 13 Successful Strategies to Reduce Stroke Risk Each group received the same 30-minute face-to-face health interview The BI group received 15 minutes of more individualized motivational counseling encompassing the FRAMES strategies Interventions were targeted according to patient specific goals A log was provided to track goal achievement

14. 14 Successful Strategies to Reduce Stroke Risk The BI group received another 15 minutes interview at 4-6 weeks and 3 months The BI group achieved a high number of newly initiated stroke-risk reduction behaviors Source: Miller E T, Spilker J, Journal of Neuroscience Nursing, Aug 2003, 35: 215-222

15. 15

16. 16 Take Control of Your Health Record Commit to Control Your Risk of Recurrent Stroke