ABSTRACT
Introduction: The nursing workforce across stroke services is integral to the delivery of specialist stroke care Despite this, nursing interventions and patient contact time are not captured via the SSNAP audit as other disciplines are, resulting in the stroke nursing workforce being influenced by local priorities with poor provision largely unrecognised. Furthermore, staffing constraints caused by covid 19 has resulted in the redeployment of specialist nurses, directly impacting the immediate provision of stroke care and depriving stroke units of clinical expertise. Method(s): Quantitative and qualitative methods were applied. This included data relating to nursing establishments, vacancies, bed configurations, electronic rostering systems and the safer nursing care tool. This information was supported by written evidence from senior stroke nursing leads. Analysis of fifteen acute stroke services was completed. Result(s): A detailed regional report was compiled and shared system wide. Each provider was presented with an individual analysis. Over 60 key findings and 19 recommendations covering four main themes were established including: Establishments against national guidance unrealised. HASUs staffed against Safecare sitting below RCP recommendations HASU beds are not recognised on electronic rosters leading to general ward theories being applied. Significant movement of band 5 nurses affecting retention. HASU beds poorly aligned with significant variations of admissions per bed. Specialist nursing team management influencing SSNAP attainment. Conclusion(s): Poor understanding of stroke nursing requirements is evident regionwide. The use of healthroster and safecare tools in stroke units is inappropriately utilised and poorly understood. There is a direct correlation between specialist nurse organisation and SSNAP achievement.
ABSTRACT
Introduction: The SSNAP stroke unit domain audit results have declined during the covid-19 pandemic. As recovery plans are implemented regionally, this study aims to understand the barriers to rapid admission to stroke speciality beds. Findings will inform quality improvement opportunities and change. Method(s): A mixed method approach was applied. Details pertaining to all patients that breached the four hour standard were collected across fourteen acute services for two months. This included all patients that were following the stroke pathway irrespective of final diagnosis. Additionally, details of all protocols pertinent to this KPI were established to identify effectiveness of local policy. The bed management was investigated for efficacy (stroke teams verses other) and differences in and out of hours explored. Covid as a direct cause was examined. Result(s): Analysis continues, however preliminary regional and team centred reports are collated. Eleven policies were examined. A negative association was identified between policies in place and admissions within four hours. A positive correlation existed between stroke team management of speciality beds and timely admissions, however, 67% of SU's were managed by other teams. 20% of breaches were multifactorial. Four covid related causes were detected. More breaches occurred in hours. The day of the week had no direct association with admission delay. Robust management of medical outliers is fundamental. Conclusion(s): Initial findings do not support assumptions. SU beds are not well managed well despite policies in place to support this. Breaches to stroke unit admissions is multifactorial but the failure to safeguard stroke speciality beds is key.