London, United Kingdom 2013 Poster Session Nurses/AHP’s Cerebrovasc Dis 2013; 35 (suppl 3)1-854 213 2033 Stroke care problems Implementing a Stepped Approach to Psychological Care Across the Stroke Pathway: A Survey to Identify Existing Staff Attitudes, Knowledge and Skills, aiming to Maximise exist-ing Resource Use. M.S. Heinke1, C. Julien2, L. Blubert3, R. Simkiss4 Improving Access to Psychological Therapies, iCope service, Camden and Islington NHS Foundation Trust, London, UK, London, UNITED KINGDOM1, Rehabilitation and Health Psychology Service, Barts Health NHS Trust, London, UK, London, UNITED KINGDOM2, Com-munity Stroke Team, Barts Health NHS Trust, London, UK, London, UNITED KINGDOM3, Reha-bilitation and Health Psychology Service, Barts Health NHS Trust, London, UK, London, UNITED KINGDOM4 Background NHS Stroke Improvement (2011) recommend a stepped-care approach to providing psychological care after stroke. This means that all staff are competent at dealing with the psychological prob-lems common to many or most people with stroke (level 1). All staff also know what to do when problems interfere with rehabilitation (levels 2 & 3). Prior to implementing a stepped-care training programme, a measure was developed to identify existing attitudes, knowledge and skills about psy-chological care after stroke, with a view to engaging staff, tailoring training and maximising existing resources. Method A non-standardised questionnaire was developed, aiming to identify staff attitudes towards knowl-edge and skills about provision of psychological care after stroke. This included assessment, inter-ventions, existing screening procedures, plus barriers to providing psychological care. Staff across the stroke pathway (inpatient acute, inpatient rehabilitation and community multi-disciplinary teams) were interviewed to complete the measure. Results Forty-nine staff members, representing the main professional groups across the stroke pathway, completed the survey. Staff identified psychological care as very relevant to their work. Lack of time and reduced confidence were the major barriers to providing psychological care. Most staff had pri-or training in communication skills. Few had been trained in psychological skills. Staff priorities for training were understanding adjustment after stroke, identifying and screening for distress, motiva-tional interviewing and supporting distressed families. Conclusion To tailor the introduction of a stepped care approach to providing psychological care across a stroke pathway, a survey was developed to identify specific training needs for staff. In engaging with staff needs, training was developed to maximise use of existing resources and develop skills, to embed psychological care throughout the stroke pathway. 2034 Stroke care problems Discovering actual pathways for people with stroke in London H.J. Cutting1, A. Rudd2, J. Lailey3 North East London Cardiovascular and Stroke Network, London, UNITED KINGDOM1, Guys and St Thomas Hospital Trust, London, UNITED KINGDOM2, North East London Cardiovas-cular and Stroke Network, London, UNITED KINGDOM3 Background The Pan London Stroke Group (PLSG) suspected that a significant number of stroke survivors were being transferred from acute stroke units (ASU) to inpatient units in order to continue rehabilita-tion. These units were not part of the identified London model and had therefore not been reviewed against existing quality standards. Method Inpatient units were identified that were not designated ASUs, but provided rehabilitation to more than 10 stroke survivors each year. The context and structure, such as staffing levels and length of stay, were collected via questionnaire. Service delivery in each unit was explored through visits and discussion with the PLSG led by the clinical lead for stroke in London. The quality of care offered was measured against existing standards developed for London acute stroke units. Results 20 units were identified across London that were not designated ASUs, but manage more than 10 stroke survivors each year. Data indicated that there are wide variations in the number of units avail-able across London, and variation in staffing levels, length of stay and intensity of rehabilitation. Conclusions This study has provided a map of the inpatient pathway of care in London, which was previously unknown. Many patients in these units still require active rehabilitation and it seems appropriate to use standards for ASUs as the benchmark against which to compare services. If stroke survivors are going to be recommended for inpatient rehabilitation at a different facility to ASU there need to be clearly identified clinical rationale. Although the configuration of hyper-acute stroke units and ASUs has parity across the capital the data collected through this project would suggest that the use of these units varies considerably and further investigation is warranted.
Karger_ESC London_2013
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