DISCHARGE FROM THE HOSPITAL
As the time of discharge approaches, a patient’s limitations are assessed formally by specialists—including physical therapists, occupational therapists, speech-language pathologists, psychologists, and nutritionists. These professionals then make recommendations that can be taken into account before physicians begin discharging the patient. Nurses on the stroke team also initiate the patient’s transition into the appropriate supervised rehabilitation programs.
Preventing Secondary Stroke
The risk for a secondary stroke is as high as 23% within the first year (Johns Hopkins Medicine, 2022). Controlling risk factors for stroke is critical in the prevention of a secondary stroke. Risk factor control is affected by patient, provider, and system level factors.
Studies show that stroke survivors who participate in rehabilitation programs that include exercise combined with education and counseling show improvements in fitness, cholesterol levels, and body weight, as well as a decrease in secondary stroke.
Stroke patients are encouraged to take medications, such as anticoagulants, antihypertensives, and statins, according to their healthcare professional’s instructions. Lifestyle habits are assessed; and shared decision-making between the healthcare professional and the patient addresses the patient’s wishes, goals, concerns, and circumstances. Formal programs in which physicians and other healthcare professionals help patients change their routines and behavior can help stroke survivors make, and keep, needed lifestyle changes (AHA, 2021d).
The mnemonic ABCDE describes important elements in preventing secondary stroke (see table below).
| Element | Examples | |
|---|---|---|
| (Silver, 2021) | ||
| A | Antiaggregants |
|
| Anticoagulants |
|
|
| B | Blood pressure-lowering medications |
|
| C | Cholesterol-lowering medications |
|
| Cessation of smoking |
|
|
| Carotid revascularization | n/a | |
| D | Diet |
|
| Diabetes control | n/a | |
| E | Exercise |
|
Patient and Family Education and Support
Following stroke, patients and families are typically faced with multiple life changes and challenges as the patient transitions through the stages of recovery. Both the patient and family should be assessed, educated, and prepared for transitions between care stages and settings and screened for level of coping, risk for depression, and other physical and psychological issues.
Education and support for patient, families, and caregivers may include:
- Written discharge instructions and recommendations that identify collaborative action plans, follow-up care, and goals
- Accurate and up-to-date information about the next care setting, what can be expected, and how to prepare
- Access to restorative care and active rehabilitation to improve and/or maintain function based on the individualized care plan
- Access to a designated contact person in the hospital or community for continuity of care and queries
- Ongoing access to and advice from health and social service organizations appropriate to needs and stages of transition and recovery
- Links to and information about local community agencies, such as stroke survivor groups, peer survivor visiting programs, meal provider agencies, and other services and agencies
- Shared decision-making/participation regarding transitions between stages of care
- Counseling, preparation, and ongoing assessment for adjustment to:
- Change of living setting
- Change in physical needs and increased dependency
- Change in social roles and leisure activities
- Impact on other family members (e.g. spouse or partner, children)
- Loss of home environment
- Potential resource issues
- Advance care planning, palliative care, and end-of-life care, as applicable
(Canadian Stroke Best Practices, 2019)