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Inicio Revista Científica de la Sociedad Española de Enfermería Neurológica (Englis... Implementation results of a Best Practice Guideline in stroke patients hospitali...
Journal Information
Vol. 47. Issue C.
Pages 18-25 (January - June 2018)
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568
Vol. 47. Issue C.
Pages 18-25 (January - June 2018)
Original article
DOI: 10.1016/j.sedeng.2018.04.001
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Implementation results of a Best Practice Guideline in stroke patients hospitalized
Resultados de la implantación de una Guía de Buenas Prácticas en pacientes con ictus hospitalizados
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568
Sonia Piñero-Sáeza,
Corresponding author
ary_son@hotmail.com

Corresponding author.
, M. Pilar Córcoles-Jiménezb, M. Victoria Ruiz-Garcíaa
a Servicio de Urgencias, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
b Área de Formación Continuada e Investigación, Gerencia de Atención Integrada de Albacete, Albacete, Spain
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Tables (3)
Table 1. Comparability of the groups between the different times of the study.
Table 2. Percentages of compliance with the guideline recommendations.
Table 3. Outcome variables in the patient in the different study periods.
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Abstract

Stroke is a significant cause of morbidity and mortality in adults and implies high social and health costs. Best Practice Guidelines (BPG) are useful tools for improving patient health outcomes and quality of care.

Aim

To evaluate the results of BPG implementation in the care of hospitalised stroke patients.

Method

Pre-post quasi-experimental study. Sample: 18 years old or older with a stroke diagnosis admitted to Albacete General Hospital. Duration or Timeline: Baseline measurement (T0; December 2014); Implementation start (T1; October–December 2015); Consolidation (T2; January–December 2016). Variables: Independent; implementation of the guideline “Stroke assessment across the continuum of care”.

Results

(i) Implementation process: neurological assessment, dysphagia, fall risk, pain detection, pressure ulcer development risk (PUD), health education. (ii) Patient results: Aspiration pneumonia, falls, independence for basic activities of daily life (ADL), PUD, pain.

Results

457 patients (30 T0, 66 T1, 361 T2). 64.1% men, mean age 68.8years; ischaemic stroke 76.1%, 16.8% transient ischaemic attack (TIA), and 7% haemorrhagic. There were no statistically significant differences in age, sex and independence for ADL between periods, but there were regarding types of stroke diagnoses. There were significant improvements in all process variables per period. The patient results were: 6 pneumonias, 3 PUD and 7 falls; 54.5% patients had ADL independence at discharge.

Conclusions

There were good implementation results of all recommendations, detecting possibilities of improvement in dysphagia assessment and independence assessment at discharge, providing healthcare education and filling of records.

Keywords:
Stroke
Practice guideline
Outcome and process assessment (health care)
Nursing care
Resumen

El ictus es una causa importante de morbimortalidad en adultos y supone un elevado coste sociosanitario. Las Guías de Buena Práctica Clínica (GBP) son herramientas útiles para mejorar los resultados en salud de los pacientes y la calidad de los cuidados.

Objetivo

Evaluar los resultados de implantación de una GBP para la atención de pacientes con ictus hospitalizados.

Método

Estudio cuasi-experimental pre-post. Mayores de 18 años ingresados en el Complejo Hospitalario Universitario de Albacete con diagnóstico de ictus. Periodos: Medición basal (T0; diciembre 2014); Inicio implantación (T1; octubre-diciembre 2015); Consolidación (T2; enero-diciembre 2016). Variables: Independiente: Implantación de la guía «Valoración del ictus mediante atención continuada». Variables de resultado: a)Proceso implantación: Valoración neurológica, disfagia, riesgo caídas, detección dolor, riesgo lesión por presión (LPP), educación sanitaria. b)Sobre el paciente: Neumonía por aspiración, caídas, independencia para actividades básicas de la vida diaria (ABVD), LPP, dolor.

Resultados

Un total de 457 pacientes (30 T0; 66 T1; 361 T2); 64,1% hombres, edad media 68,8años; ictus isquémicos 76,1%, 16,8% AIT y 7% hemorrágicos. No existieron diferencias estadísticamente significativas en edad, sexo e independencia para las ABVD entre periodos, sí respecto al tipo de ictus. En todas las variables de proceso se produjeron mejoras significativas por periodos. Como resultados en pacientes se produjeron 6 neumonías, 3 LPP y 7 caídas; un 54,5% eran independientes para las ABVD al alta.

Conclusiones

Existen buenos niveles de implantación de todas las recomendaciones, detectando posibilidades de mejora en valoración de disfagia e independencia al alta, proporcionar educación sanitaria y sobre la cumplimentación de registros.

Palabras clave:
Accidente cerebrovascular
Guía de práctica clínica
Evaluación de procesos (atención de salud) y resultados
Atención de enfermería
Full Text
Introduction

According to the World Health Organisation (WHO), cerebrovascular disease is the second cause of death worldwide. In 2015, 6.24 million people died across the world as a consequence of this disease.1 Stroke is a brain injury caused by a sudden disruption in blood flow, due to an obstructed (ischaemic stroke) or ruptured (haemorrhagic stroke) artery.2 There are between 80,000 to 90,000 new cases3 annually in Spain. The incidence is higher in men and reaches a peak at the age of 85 years. It is the main cause of death for women and its sequelae constitute the primary cause of disability in adults.4 Prevalence increases with age and, due to our society's increased life expectancy, entails major needs and demands with the consequent increased social and health costs.5 It is estimated that the hospital cost of cerebrovascular disease in Spain during 2004 was 1526 million euros,6 and added to this are the consequences in terms of years living with a disability.6

Institutions have drawn up various plans to improve prevention and the care and rehabilitation of these patients, from the Health Department (“National Health System Stroke Strategy” as part of the Quality Plan7) to the WHO and the European Stroke Council (Helsinborg Declaration8 on European stroke strategies, which sets out management objectives). Comprehensive assessment of the stroke patient involves an interdisciplinary approach in which nurses play an important role in patient screening and evaluation, and in identifying complications.

Best Practice Guidelines (BPG) are a set of recommendations that have been systematically developed to help healthcare professionals and users in health-related decision-making.9 Their implementation is an acknowledged strategy to improve health care, its effectiveness and efficiency, and to reduce variability of care.9–11 These BPG should be evaluated using tools to demonstrate how effective they are in both adapting care processes and in patient outcomes.9

In this context, the Registered Nurses’ Association of Ontario (RNAO) set up the Best Practice Spotlight Organisation (BPSO®) in 1999 to develop, disseminate, implement and evaluate BPG. The Spanish centre for evidence-based healthcare — a Joanna Briggs Institute Centre of Excellence — in collaboration with the Healthcare Research Unit (Investén-isciii) and the RNAO, started the BPG implementation programme in Spain in 2011. This resulted in the Centres Committed to Excellence in Care (CCEC®) initiative: institutions committed to implementing, assessing and maintaining BPG to improve care.11 The implementation of these guidelines seeks to facilitate the transfer of knowledge to daily clinical practice in the area of nursing care. Albacete's General Hospital (CHUA) joined the CCEC® initiative in 2012. In 2015 they started to implement the guideline “stroke assessment across the continuum of care”, which contains recommendations for nurses based on the best available evidence for stroke patient care.2

The general aim of this study was to evaluate the results of implementing a BPG for the care of hospitalised stroke patients.

The specific objectives were: to examine the implementation of the BPG recommendations by nurses, to identify stroke patient outcomes in terms of dependence, hospital falls, incidence of pressure ulcers (PU) and pneumonia, and to determine any improvements in the application of the recommendations and patient outcomes over the time that the BPG were implemented.

MethodDesign

Quasi-experimental study pre-post implementation of a BPG.

Scope

The stroke unit and neurology ward of the CHUA.

Population and sample

Inclusion criteria: everyone over the age of 18 years admitted to the neurology department of the CHUA with a diagnosis of transitory ischaemic accident (TIA), ischaemic or haemorrhagic stroke during the study periods.

There were no exclusion criteria.

Three phases were examined: baseline measurement (T0; December 2014; as a reference prior to implementation); start of implementation (T1; October–December 2015), and consolidation (T2; January–December 2016). All the patients who met the criteria in each of these three phases were included in the study.

Variables

  • Patient features: sex, age, hospital stay, type of stroke (TIA, ischaemic or haemorrhagic).

  • Independent variable: implementation of BPG recommendations. This was undertaken according to the “BPG implementation tool”,12 with the objective of facilitating the implementation and sustainability of BPG in institutions. The guideline was presented to the multi-professional team of the neurology department at the beginning of 2015. A team (neurologists, nurses and assistants) to drive the initiative met to examine the barriers and enablers of implementation and to select the recommendations that it would be feasible to implement in hospitals. By consensus, they agreed to implement the following recommendations: “conduct a neurological assessment using a scale on admission, and when there is a change in client status”, “clients with identified signs and symptoms of neurological deterioration should be referred to a trained healthcare professional”, “risk assessment for PU, risk of falls and pain using a validated tool”, “dysphagia screen in the first 24h post stroke completed with neurological changes”, “assessment of the ability to perform the basic activities of daily living (ADL) using a validated tool” and “assessment of the patient's and their caregiver's learning needs”, all with a level of evidence iv.2 The stroke patient protocol was reviewed and updated, and two continuous training days were held on updating knowledge and the recommendations to be implemented, to ensure that all the professionals were familiar with them. The computerised clinical history records were adapted.

  • Outcome variables and measurement tools:

  • a)

    Variables of the outcomes after the implementation of the recommendations:

  • Neurological assessment (first 24h of admission) using the Canadian Scale.13 Assess mental status (level of consciousness, orientation and language) and motor function (face, arms and legs, adapted in the event of problems with understanding). Maximum score 10 points and maximum neurological impairment 1.5 points. A reduction of 1 point indicates altered neurological status.

  • Neurological assessment after every change in neurological status (Canadian Scale).

  • Consult a specialist after detecting neurological changes. Direct notification (in person or by telephone) and record in clinical history.

  • Dysphagia assessment (first 24h following admission). Water swallow test.14 Tests swallowing function after administration of water with a syringe, assessing dribbling, laryngeal movement, cough and stridor. First, 2ml of water are administered. Then, if swallowing is not impaired, 10ml are administered. If swallowing is efficient, the patient is offered 50ml in a glass. The result can be: normal swallowing, mild, moderate or severe dysphagia. The test is not applicable if the patient is admitted with a prescribed diet or fasting (the neurologist performs the test) or if they require admission to critical care in the first 24h.

  • Dysphagia assessment pre oral intake (water swallow test).

  • Fall risk assessment on admission (first 24h). J.H. Downton scale.15 Assesses: previous falls, medication, sensory deficits, mental status and balance according to ability to walk. A score <3 is classified as low risk and ≥3 points high.

  • Detection of pain intensity (first 24h following admission and after clinical changes) using numerical scale of visual analogue scale (VAS).16 The patient scores their pain intensity from 0 to 10. Classification: no pain, 0; mild, 1–2; moderate, 3–5; intense, 6–8; unbearable, 9–10.

  • Assessment of pressure ulcer (PU) (first 24h) using the Braden scale.17 Assesses 6 items (sensory perception, skin exposed to moisture, activity, mobility, nutrition, friction and/or shear). Scores range from 6 to 23. Classification: very high risk (score ≤9); high risk (10–12 points), moderate risk (13–14 points) and low risk (15–18 points).

  • Provision of health education for the patient and their family members during admission and information leaflet prepared by the neurology department.18 Including recommendations on: physical and mental stimulation, nutrition, elimination, hygiene, dressing, mobilisations, respiratory secretions, communication, sleep and rest, architectural barriers, leisure and recreational activities and sexuality. Education is provided orally and individually in the stroke unit during visiting times, and reinforced with the information leaflet.

  • Establishing degree of independence for ADL (24h before discharge) using the Barthel index.19 Testing activities of eating, washing/bathing, dressing, grooming, bowel, urine, toileting, seat/chair transferring, ambulating and going up and down stairs, scored from 0 to 100: total dependence (<20); severe (20–35); moderate (40–55); mild (≥60); independence (100).

  • b)

    Outcome variables in the patient:

  • Number of aspiration pneumonias, identified by diagnosis in medical discharge report.

  • Number of falls during admission.

  • Pain intensity in first 24h following admission and maximum intensity during admission.

  • Number and type of PU.

  • Situation of Independence for ADL on discharge.

Data collection

Forming part of the programme of the Centres Committed to Excellence in Care (CCEC®) involves a commitment to performing monthly evaluations of the implementation recommendations and patient outcomes, in order to see the real effectiveness of the recommendations in the specific healthcare environment where they are being applied. There is an agreed dictionary of indicators to prevent variability. The indicators are assessed from forms and information exported from computerised clinical history records (Mambrino XXI®) to anonymised tables within the care quality assessment frameworks. This information is transferred to an online platform (CarEvID+®) with no information that would enable identification of the subjects, thus establishing a global database registered in the Spanish Data Protection Agency. Access to the database is restricted to designated managers in each centre (including the researchers of this study) and the Programme Coordinating Centre.

Statistical analysis

SPSS v22 was used for the statistical analysis.

Descriptive analysis

Absolute and relative frequencies were used for the qualitative variables, measures of central tendency and dispersion (standard deviation [s.d.]) for the quantitative variables. Ninety-five percent confidence intervals (CI) were calculated. The normality of distribution of the quantitative variables was checked using the Kolmogorov–Smirnov test.

Bivariate analysis

Comparison of the variables between groups was performed using ANOVA and the chi-squared test according to the nature of the variables. The level of significance was established for p values <.05.

Ethical aspects

When they join the CCEC® network, everyone involved in assessment processes signs a confidentiality agreement and agrees to follow the best clinical practice standards, complying with current national and international legislation. Anonymous data was used for this study from the databases of the CCEC® Programme, collected to assess the quality of implementation of the recommendations. Therefore no patient consent was sought, since their data had been irreversibly disassociated beforehand.

Results

During the study period, 457 patients were assessed: 30 at T0, 66 at T1 and 361 at T2. Sixty-four point one percent (293) were male. The mean age on admission was 68.8 years (s.d.=12.8), 95% CI: 67.6–70. The mean hospital stay was 5.6 days (s.d.=5.2), 95% CI: 5.1–6.1. In terms of stroke type, 76.1% (348) were ischaemic, 16.8% (77) TIA and 7% (32) haemorrhagic.

In terms of the homogeneity of the groups, it was confirmed that there were no statistically significant differences between the patients included in the different periods in terms of sex, age, independence for ADL at time of admission, but there were with regard to type of stroke (Table 1).

Table 1.

Comparability of the groups between the different times of the study.

  T0, % (nT1, % (nT2, % (np 
Sex.326 
Males  63.3 (19)  56.1 (37)  65.7 (237)   
Females  36.7 (11)  43.9 (29)  34.3 (124)   
Type of stroke.026 
TIA  10 (3)  15.2 (10)  17.7 (64)   
Ischaemic  90 (27)  69.7 (46)  76.2 (275)   
Haemorrhagic  0 (0)  15.2 (10)  6.1 (22)   
  T0, mean (s.d.)  T1, mean (s.d.)  T2, mean (s.d.)  p 
Age  73.7 (10.6)  68.6 (12.6)  68.4 (12.9)  .094 
Independence for ADL on admission  72 (31.7)  78.9 (30.6)  78.5 (30.6)  .488 

In all the indicators, the implementation process of the guidelines resulted in significantly significant improvements per period (Table 2). Eighty-five point three percent (354) had a low risk of falls and 88.2% (365) had a low PU risk.

Table 2.

Percentages of compliance with the guideline recommendations.

  T0 (n=30), % (nT1 (n=66), % (nT2 (n=361), % (np 
Neurological assessment in the first 24h<.0001 
Yes  83.3 (25)  90.9 (60)  90.9 (328)   
No  16.7 (5)  0 (0)  2.8 (10)   
Not applicable  0 (0)  9.1 (6)  6.4 (23)   
Reassessment after neurological impairment.005 
Yes  10 (3)  13.6 (9)  29.9 (108)   
No  0 (0)  0 (0)  2.2 (8)   
Not applicable  90 (27)  86.4 (57)  67.9 (245)   
Referral to specialist after impairment.004 
Yes  10 (3)  13.6 (9)  29.9 (108)   
No  0 (0)  0 (0)  2.5 (9)   
Not applicable  90 (27)  86.4 (57)  67.6 (244)   
Dysphagia assessment in first 24h<.0001 
Yes  3.3 (1)  18.2 (12)  55.4 (200)   
No  96.7 (29)  71.2 (47)  25.5 (92)   
Not applicable  0 (0)  10.6 (7)  19.1 (69)   
Dysphagia assessment pre-intake<.0001 
Yes  6.7 (2)  21.2 (14)  56.2 (203)   
No  73.3 (22)  72.7 (48)  26.3 (95)   
Not applicable  20 (6)  6.1 (4)  17.5 (63)   
Fall risk assessment<.0001 
Yes  93.3 (28)  86.4 (57)  93.9 (339)   
No  6.7 (2)  4.5 (3)  5.3 (19)   
Not applicable  0 (0)  9.1 (6)  .8 (3)   
Pressure ulcer assessment<.0001 
Yes  93.3 (28)  86.4 (57)  93.6 (338)   
No  6.7 (2)  4.5 (3)  5.5 (20)   
Not applicable  0 (0)  9.1 (6)  .8 (3)   
Pain assessment on admission<.0001 
Yes  80 (24)  89.4 (59)  89.5 (323)   
No  20 (6)  1.5 (1)  3.6 (13)   
Not applicable  0 (0)  9.1 (6)  6.9 (25)   
Pain assessment after clinical changes<.0001 
Yes  0 (0)  13.6 (6)  29.4 (106)   
No  16.7 (5)  6.1 (4)  9.7 (35)   
Not applicable  83.3 (25)  80.3 (53)  60.9 (220)   
Health education.017 
Yes  23.3 (7)  36.4 (24)  47.1 (170)   
No  76.7 (23)  63.6 (42)  52.9 (191)   
Determination of independence for ADL on discharge.003 
Yes  0 (0)  12.1 (8)  29.1 (105)   
No  100 (30)  87.9 (58)  69 (249)   
Not applicable  0 (0)  0 (0)  1.9 (7)   

Ninety-six point nine percent (437) of the patients started an oral diet. Mild dysphagia was detected in 3 patients (.9% of the total assessed) and moderate/severe in 4 (1.2%).

In terms of patient outcome variables, there were 6 cases of aspiration pneumonia (1.3% of the total patients). There were also 3 cases of PU (meaning an incidence of .7%): two developed during admission to the neurology department and one from the patient's stay in resuscitation; the affected area was the sacrum and all three were grade II ulcers. There were a total of 7 falls (1.5% of the total patients). Table 3 shows the comparison of the outcome variables between the periods.

Table 3.

Outcome variables in the patient in the different study periods.

  T0, % (nT1, % (nT2, % (np 
Pneumonias.399 
Yes  3.3 (1)  0 (0)  1.4 (5)   
No  96.7 (29)  100 (66)  98.6 (356)   
Falls.088 
Yes  0 (0)  4.5 (3)  1.1 (4)   
No  100 (30)  95.5 (63)  98.9 (357)   
Pressure ulcers.669 
Yes  0 (0)  0 (0)  .8 (3)   
No  100 (30)  100 (66)  99.2 (358)   
  Mean T0 (s.d.)  Mean T1 (s.d.)  Mean T2 (s.d.)  p 
Maximum pain  .48 (.97)  .83 (1.36)  1 (1.76)  .25 
Hospital stay (days)  5.2 (3.57)  5 (3.65)  5.75 (5.59)  .51 

Only 113 patients were assessed for independence for ADL on discharge. Fifty-four point 5 percent of these scored 100 (independence), whereas 17% scored less than 60.

The mean intensity of maximum pain during admission was .9 (s.d.=1.6), 95% CI: .8–1.1. Fourteen point six percent had moderate pain (3–5) and 2.3% severe pain (>6). The intensity was greater in the women (1.4 vs .69; p<.0001).

Discussion

In relation to stroke type and patient features, the results of this study coincide with the literature in the percentage of ischaemic and haemorrhagic strokes found,5 as well as the mean age of the stroke patients,20,21 which highlights the need to underscore prevention in these types of patients.

The mean hospital stay was less than that of other studies,22 which confirms the impact of the stroke unit on the outcome of the disease and reduced hospital stay.20

All the results of implementing the guideline showed statistically significant improvement between the study periods, which demonstrated the commitment and involvement of nurses in improving evidence-based clinical practice.

According to the literature, up to 30% of stroke patients have neurological impairment in the first 24h, and up to 64% have some complication during the first week.23,24 In this study the percentage was less. However, a record was not found for all the patients who underwent reassessment and referral to a specialist due to neurological impairment. This shortcoming has also been observed in other studies on the implementation of this BPG.25 It might be attributed to under-recording, but in any case this is an area for improvement, since indentifying incipient impairment would enable any complication to be attended promptly.

The assessment and recording of dysphagia on admission and prior to oral intake also increased, and it was found that the majority of the patients started an oral diet with no swallowing impairment. Unlike other studies,26,27 with an incidence ranging from 19% to 81% depending on the detection method used, only 2.1% presented dysphagia in the first 24h following admission, although the assessment was only recorded for two thirds of the patients. The consequence for half the patients with impaired swallowing of any type is aspiration pneumonia, with associated mortality of up to 50%.27 In this study, the incidence of pneumonia was minimal and the cases were resolved with no complications.

Stroke patients have a greater fall risk for various reasons (cognitive deficit, sight or sensory loss, incontinence, postural instability, sequelae, fear).2,22,28 Only 1.53% of the patients suffered a fall, which is a very low percentage, but we must concentrate on prevention to prevent added complications to the disease.

The incidence of UP was also low compared to other studies (1.2%).22 Nursing staff must be vigilant for this complication with early prevention and care since, like falls, these are considered an adverse effect of healthcare.29

Pain (headache, shoulder pain, spasticity) can also have consequences, hence the importance of early detection and intervention.2 The results showed high compliance with this recommendation and that the patients had mild pain on average. However, pain control should continue to be improved, especially for women.

Stroke entails a high degree of disability that affects the patients’ quality of life and can lengthen hospital stay if families do not feel able to provide the appropriate care.30 Therefore it is important to assess the functional ability of stroke patients and educate their families to participate in their care with a view to discharge from hospital. As in other studies,25 this was found to be an area for improvement.

Possible limitations of this study are that the data were obtained from records. A failure to keep full records on the implementation of this PBG was also detected in other studies.25 In order to improve record-keeping training days were held before and during implementation, and nursing management provided their express support.

In terms of the implications for practice, the use of BPG has enabled areas for improvement to be detected, variability of care to be reduced, and for the systematic use of validated and standardised assessment tools to be systematised for the early detection of complications that might aggravate the morbidity and mortality of stroke patients. It is important to make professionals aware of the importance of records, because they provide better visibility to the work of nurses in providing documentation of the work undertaken, and they improve interdisciplinary communication and continuity of care, not to mention the legal implications. Furthermore, they will make it possible to continue research to provide better evidence on the outcomes of BPG implementation.

Conclusions

The results show good levels of implementation of all the recommendations of the guidelines, which improved over time. However, room for improvement was detected in assessing dysphagia, providing education and assessing independence for ADL on discharge, and in record keeping, which will prove a challenge in the short to medium term.

Financing

The good practice implementation programme for Centres Committed to Excellence in Care® is part-financed by the Spanish Collaborating Centre of the Joanna Briggs Institute.

Conflict of interests

The authors have no conflict of interests to declare.

Acknowledgements

Our thanks go to all the professionals of the Albacete General Hospital for their work over the years in the care of stroke patients and their families, and the records they have kept, without which it would have been impossible to undertake this study.

This study was undertaken partially using data and the methodology for the implementation of best practice guidelines in Centres Committed to Excellence in Care®. The authors would like to express their gratitude to the Working Group for the implementation of best practice guidelines in Centres Committed to Excellence in Care®.

References
[1]
Organización Mundial de la Salud. Las 10 principales causas de defunción. Nota descriptiva núm. 310, enero 2017 [accessed 3 Mar 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs310/es/
[2]
Registered Nurses Association of Ontario [RNAO]. Investén-isciii. Valoración del ictus mediante la atención continuada [accessed 3 Mar 2018]. Available from: http://www.evidenciaencuidados.es/es/attachments/article/46/D0024_Val oracionIctus_spp_2011.pdf
[3]
J. Díaz Guzmán, J.A. Egido, R. Gabriel-Sánchez, G. Barberá-Comes, B. Fuentes-Gimeno, C. Fernández-Pérez, on behalf of the IBERICTUS-study Investigators.
Stroke and transient ischemic attack incidence rate in Spain: The IBERICTUS study.
Cerebrovasc Dis, 34 (2012), pp. 272-281
[4]
R. Boix, J.L. del Barrio, P. Saz, R. Reñé, J.M. Manubens, A. Lobo, et al.
Stroke prevalence among the Spanish elderly: an analysis based on screening surveys.
[5]
A. Brea, M. Laclaustra, E. Martorell, A. Pedragosa.
Epidemiología de la enfermedad vascular cerebral en España.
Clin Invest Arterioscl, 25 (2013), pp. 211-217
[6]
J. Mar, J. Álvarez-Sabín, J. Oliva, V. Becerra, M.A. Casado, M. Yébenes, et al.
Los costes del ictus en España según su etiología. El protocolo del estudio CONOCES.
Neurologia, 28 (2013), pp. 332-339
[7]
Estrategia en Ictus del Sistema Nacional de Salud. Sanidad 2008. Ministerio de Sanidad y Consumo. Centro de Publicaciones [accessed 3 Mar 2018]. Available from: http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/docs/EstrategiaIctusSNS.pdf.
[8]
T. Kjellstrom, B. Norrving, A. Shatchkute.
Helsingborg Declaration 2006 on European stroke strategies.
Cerebrovasc Dis, 23 (2007), pp. 231-241
[9]
Guidelines for clinical practice: from development to use,
[10]
J.M. Morales Asencio, E. Gonzalo Jiménez, F. Martín Santos, J.C. Morilla Herrera, J. Terol Fernández, C. Ruiz Barbosa.
Guías de práctica clínica: ¿mejoran la efectividad de los cuidados?.
Enferm Clin, 13 (2003), pp. 41-47
[11]
M. Ruzafa Martínez, E. González María, M. Moreno Casbas, C. del Río Faes, L. Albornos Muñoz, C. Escandell García.
Proyecto de implantación de Guías de Buenas Prácticas en España 2011–2016.
Enferm Clin, 21 (2011), pp. 275-283
[12]
Versión española traducida de: Registered Nurses’ Association of Ontario.
Toolkit: implementation of best practice guidelines.
[13]
R. Cote, R.N. Battista, C. Wolfson, J. Boucher, J. Adam, V.C. Hachinski.
The Canadian Neurological Scale: validation and reliability assessment.
Neurology, 39 (1989), pp. 638-643
[14]
K.L. De Pippo, M.A. Holas, M.J. Reding.
Validation of the 3-oz water swallow test for aspiration following stroke.
Arch Neurol, 49 (1992), pp. 1259-1261
[15]
M. Aranda-Gallardo, J.M. Morales-Asencio, J.C. Canca-Sánchez, Á. Morales-Fernández, M. Enríquez de Luna-Rodríguez, A.B. Moya-Suarez, et al.
Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton.
Rev Calid Asist, 30 (2015), pp. 195-202
[16]
K.A. Herr, L. Garand.
Assessment and measurement of pain in older adults.
Clin Geriatr Med, 17 (2001), pp. 457-478
[17]
M.C. Bernal, C.L. Curcio, J.A. Chacón, J.F. Gómez, A.M. Botero.
Validez y fiabilidad de la escala de Braden para predecir riesgo de lesiones por presión en ancianos.
Rev Esp Geriatr Gerontol, 36 (2001), pp. 281-286
[18]
Recomendaciones a pacientes con ictus y sus familiares. Unidad de enfermería de neurología. Complejo Hospitalario Universitario de Albacete [accessed 3 Mar 2018]. Available from: http://www.chospab.es/enfermeria/RNAO/guias/guia-bpso-folleto_ictus.pdf.
[19]
J.J. Baztán, J. Pérez del Molino, T. Alarcón, E. San Cristóbal, G. Izquierdo, J. Manzarbeitia.
Índice de Barthel: Instrumento válido para la valoración funcional de pacientes con enfermedad cerebrovascular.
Rev Esp Geriatr Gerontol, 28 (1993), pp. 32-40
[20]
J. Álvarez-Sabín, M. Ribó, J. Masjuan, J.R. Tejada, M. Quintana, en nombre de los investigadores del estudio PRACTIC.
Importancia de una atención neurológica especializada en el manejo intrahospitalario de pacientes con ictus.
Neurologia, 26 (2011), pp. 510-517
[21]
C. Leno Díaz, M. Holguín Mohedas, N. Hidalgo Jiménez, M. Rodriguez-Ramos, J.M. Lavado García.
Calidad de vida relacionada con la salud en personas supervivientes a un ictus a largo plazo.
Rev Cient Soc Esp Enferm Neurol, 44 (2016), pp. 9-15
[22]
A. Ingeman, G. Andersen, H.H. Hundborg, M.L. Svendsen, S.P. Johnsen, A. Ingeman, et al.
In-hospital medical complications length of stay, and mortality among stroke unit patients.
Stroke, 42 (2011), pp. 3214-3218
[23]
D. Summers, A. Leonard, D. Wentworth, J.L. Saver, J. Simpson, J.A. Spilker, et al.
Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient: a scientific statement from the American Heart Association.
Stroke, 40 (2009), pp. 2911-2944
[24]
M.P. Lindsay, G. Gubitz, M. Bayley, M.D. Hill, C. Davies-Schinkel, S. Singh, On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group, et al.
Canadian best practice recommendations for stroke care (update 2010).
Canadian Stroke Network, (2010),
Available from: http://www.strokebestpractices.ca/index.php/resources/ [accessed 03.03.18]
[25]
M. Singh, M. Hynie, T. Rivera, L. Macisaac, A. Gladman, A. Cheng.
An evaluation study of de implementation of stroke best practice guidelines using a Knowledge Transfer Team approach.
Can J Neurosci Nurs, 37 (2015), pp. 24-33
[26]
R. Martino, N. Foley, S. Bhogal, N. Diamant, M. Speechley, R. Teasell.
Dysphagia after stroke: incidence, diagnosis, and pulmonary complications.
[27]
P. Clave, V. Arreola, M. Romea, L. Medina, E. Palomera, M. Serra-Prat.
Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration.
Clin Nutr, 27 (2008), pp. 806-815
[28]
J. Minaya-Sáiz, A. Lozano-Menor, R.M. Salazar de la Guerra.
Abordaje multidisciplinar de las caídas en un hospital de media estancia.
Rev Calid Asist, 25 (2010), pp. 106-111
[29]
Joint Commission. Sentinel Event Statistics, 2007. Available from http://www.jointcommission.org/SentinelEvents/Statistics/ [accessed 03.03.18].
[30]
A. Moreno Verdugo, A. de la Fuente García, R. Caro Quesada, D. Suso López, A. Durán Rodríguez.
Programa de educación a cuidadores informales de pacientes con ictus, para favorecer la continuidad de los cuidados al alta hospitalaria.
Rev Cient Soc Esp Enferm Neurol, 25 (2007), pp. 14-27

Please cite this article as: Piñero-Sáez S, Córcoles-Jiménez MP, Ruiz-García MV. Resultados de la implantación de una Guía de Buenas Prácticas en pacientes con ictus hospitalizados. Rev Cient Soc Enferm Neurol. 2018;47:18–25.

Copyright © 2018. Sociedad Española de Enfermería Neurológica
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