Latest Andy . . . .

https://drive.google.com/open?id=0B-9ZA7n0tr49QVBWV1FJUUplbm8

Andy- Simplified RR Wow! What just happened? I was driving into town when my vision got blurred and I couldn’t see much for a while. Then, when I got out of the gravel truck, I lost my balance and fell back against the seat. Good thing my co-worker got me to the Emergency department quickly. I’m feeling better now, but the doctor thinks I might have had a mini stroke. He says he’s going to need to send me for some tests. I have to be transferred to another hospital for a scan of my head and arteries in my neck I’m not sure why. What teaching do you think Andy is ready for at this time? a) Information about what minor stroke is (yes) b) Description of the CT scan and CT angiogram and information it provides (yes) c) Review of all risk factors for stroke (NO) This information would be better provided after diagnosis is confirmed and patient is seen in the SPC How can Andy’s transition be supported smoothly between Healthcare Centres? a) Completion of inter-facility transfer form b) Completion of CT requisition with appropriate history c) Verbal communication with EMS Dispatch d) Provide CT requisition to patient and tell him he’ll hear from you soon (NO) Communication must happen between caregivers and results need to be available today So after the scan, the doctor gives me Aspirin to take and says I can go home, but I need to be seen by a stroke specialist in Edmonton tomorrow. I wonder how that is arranged. My wife and I feel a bit overwhelmed and anxious. What if it happens again? What teaching is appropriate for Andy at this time? a) Review how Aspirin works to prevent stroke b) Provide list of community supports (NO) This information would be better provided after patient is seen in the SPC c) Have the emergency physician explain why he/she does not think admission is needed d) Review signs of stroke and advise to call 911 if they occur How can Andy’s transition be supported between the Healthcare Centre and Stroke Prevention Clinic? a) Complete SPC referral form and fax to appropriate location b) Review TIA Discharge information and advise Andy not to drive until further assessed c) Determine Andy’s resources to get to the SPC in the city d) Ask wife what her specific concerns are about managing over the next 24 hours Today I saw the stroke specialist. He reviewed the scans and said there was no evidence of stroke, but he said I had a TIA. The doctor thinks it may have been caused by my high blood pressure, but I need more tests. He said he was going to increase my medication for my blood pressure. I also found out that I have to have some vision testing before I can return to driving. My son drove us to this appointment as my wife doesn’t drive either. We are worried about my job and getting around if I can’t drive. What teaching is appropriate for Andy at this time? a) Review risk factors for stroke and lifestyle changes b) Provide information regarding tests and preparation c) Provide information regarding home BP monitoring d) Provide information about hypertension and CDM education programs How could Andy’s transition be supported at this point? a) Provide information regarding community transportation options and contact info b) Complete referral to dietician for information on reducing sodium in diet c) Assist Andy to obtain an appointment for vision testing d) Ensure prescriptions are provided to patient or faxed to pharmacy e) Complete a depression screen and refer as necessary (NO) This may be too early in his recovery but should be considered in follow up Today I saw my family doctor in the Primary Care Network. He said he had received a letter back from the stroke specialist I saw 2 weeks ago. He reviewed my blood tests and told me my bad cholesterol was high, so he was starting me on a statin medication. He had a copy of the vision test I had last week and said it was normal. As well, the heart monitor I wore for 48 hours did not show any abnormalities. He said that since I have not had any recurrence of symptoms and my blood pressure has been good, that I could return to work next week. What teaching/ assessment is appropriate for the PCN nurse to do at this point? a) Review home BP measurements and re-enforce education on hypertension management b) Review information on lipid lowering medication and diet to reduce cholesterol c) Review signs of stroke and advise to call 911 if symptoms reoccur d) Assess for readiness for change in lifestyle and support him in that area

Intro to Andy . . . . ??

New Improved

https://drive.google.com/folderview?id=0B-9ZA7n0tr49V0FCVy1vQ2lhbGM&usp=sharing

Latest Build . . . Tuesday after Valentines . ..

Things I still have to work on . . . 

1.  Making the slides run smoothly from question to question
2. Putting different  pics in  . . .  the main choice girl is copyright
3. Finding pics and pieces for some answers
1. As an example for the How aspirin works I hilighted in RED so you know this space needs help form you.
4. The  left menu you see will likely not exist in the final product, It just helps getting around this prototype.
5. 
   

https://drive.google.com/open?id=0B-9ZA7n0tr49TngyMVRVWGdMdGM 0B-9ZA7n0tr49WDN5S0JQSUVQRzg

LAtest Script Write

Thursday Draft

New Questions for Andy First Scenario

https://drive.google.com/open?id=0B-9ZA7n0tr49TngyMVRVWGdMdGM

• What if we give examples instead of just these answers?? Like APSS approved samples to look at rather than these headings ?

What teaching do you think Andy is ready for at this time?

• a)       Information about what minor stroke is (yes)
• http://www.webmd.com/stroke/news/20100415/can-you-recognize-symptoms-of-minor-stroke
• b)      Description of the CT scan and information it provides (yes)
• https://en.wikipedia.org/wiki/CT_scan
• 
  
• c)       Review of all risk factors for stroke (NO)  This information would be better provided after diagnosis is confirmed and patient is seen in the SPC
• http://www.heart.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309713.pdf

How can Andy’s transition be supported smoothly between Healthcare Centres?

• a)      Completion of inter-facility transfer form
• b)      Completion of CT requisition with appropriate history
• c)       Verbal communication with EMS Dispatch
• Provide CT requisition to patient and tell him he’ll hear from you soon 

A snapshot based on Shirley's latest script . . .

So we might give very brief snippets of each case scenario. Present  Part A and ask:

• What is the Patient ready for ( Teaching wise) ?

• What do I need to do Transition wise to improve his current journey (and his family)  thru the healthcare system? ( and maintain continuity)

A snapshot based on  Shirley's latest script . . .

Andy Case Scenario

Case Scenario- rural Andy, a 63 year truck driver, was just returning to the worksite after a delivery in the country. As he approached the traffic lights leading into town, he suddenly felt dizzy and then lost his vision.

1st Medical visit Transition

 Although in a panic, he was able to radio for help and a co-worker brought him to the local Healthcare Centre. On arrival at the HCC, his vision was improving, so the ER physician did not feel admission was warranted. Arrangements were made for Andy to be seen as an outpatient at a tertiary Stroke Prevention Clinic the following day. Andy’s wife was there to drive him home, but looked alarmed when he was being discharged.

Questions / Learning 

What teaching/ information should be provided before Andy and his wife leave the Emergency Department? (Identify 5 topics and use Patient Education across the Continuum chart) a. Current diagnosis (TIA/Minor Stroke) b. Signs of stroke and what to do-call 911 c. Diagnostic tests for cause of stroke and TIA d. Information about driving after stroke or TIA e. Importance of follow up with stroke specialist f. Importance of follow up with Primary Care Physician g. Potential causes of event and risk of recurrence h. Accessing resources and stroke support following discharge

Transition Scenario

Questions / Learning 

 As a HC Provider in ED, what forms or protocols are available to you to support Andy’s transition to the next level of care? (Identify 2) a. TIA/ Minor Stroke Order Set b. Stroke Prevention clinic referral form, completed and faxed c. TIA Discharge Information Sheet/ Checklist

Transition Scenario

Questions / Learning  ( Caregiver Assessment)

 Prior to Andy and his wife leaving the ED, what caregiver assessment should be completed? a. Confirm wife’s ability to drive patient to appointment b. Determine understanding of plan of care c. Provide opportunity to express concerns, get clarity

Caregiver Dialog Link

2nd  Medical visit Transition

 Andy was seen at the SPC where he had a head CT and CT Angiogram and was found to have had a small ischemic stroke. A repeat visual exam at the SPC confirmed a persistent loss of peripheral vision and a mild balance problem. Andy was advised not to drive due to the visual deficits, and could therefore not return to work. He was given a prescription for Aspirin 81 mg and Crestor 10 mg daily and was advised to buy a Blood Pressure monitor and check his BP daily. He was also advised that he would be scheduled for a Holter Monitor test and should have some rehab therapy to assist with recovery. Andy and his wife are concerned about him not being able to drive.

Questions / Learning 

What teaching information should be provided to Andy and his wife at this stage? a. Re-enforce information given in ED b. Confirm diagnosis c. Review importance of calling 911 if new signs of stroke d. Review risk factors for stroke and confirm which apply to Andy e. Medication teaching and management f. Expectations for recovery g. Expectations for return to work h. Criteria for driving again i. Review purpose of further testing

Questions / Learning 

As a Healthcare provider, what tools and processes support Andy’s transition back to the community? a. Early completion of stroke specialists letter back to PCN physician b. Written information regarding follow up appointments c. Advise who will take over care d. Refer to local rehab department e. Advise re local stroke support groups

3rd Medical visit Transition

 Andy was seen by his family physician within 1 week of the SPC consult. His doctor reviewed recent fasting bloodwork and his blood pressure readings since the SPC clinic visit. Andy was known to have mild hypertension for a number of years, but was reluctant to take medications. Most of the recorded BP readings this week were greater than 155 systolic and greater than 100 diastolic. Andy was advised that he needed to be on medication to control this risk for stroke. As well, his fasting lipids were elevated. His Holter monitor results were not available at this appointment. Andy told his physician that he had an appointment with the OT at the Healthcare Centre that same afternoon.

Questions / Learning 

What teaching information should be reviewed at this time? a. Provide information regarding hypertension and management b. Review information regarding lipid management c. Provide information regarding CDM education and self-management programs in community d. Discuss goal setting as a strategy to make changes in lifestyle e. Support patient centered goal setting f. Discuss follow-up g. Complete depression screen as necessary Define Collaborative Care Planning and goal setting:¬¬________

4th Medical visit Transition

 Andy was assessed by an Occupational Therapist with training in visual rehabilitation. During therapy, she was able to determine the impact of Andy’s visual deficits on his finances, emotions and relationships. She was also able to identify potential safety concerns that would have to be addressed as he returned to a new normal in life.

Questions / Learning 

Define the term “Community Re-integration”:_______________ What actions can this OT take to support Andy’s return to meaningful activities of daily living? a. Screen for other deficits that may not have been initially identified ie cognitive assessments b. Do a home visit to assess for potential safety concerns c. Provide information regarding alternate transportation options d. Re-enforce information regarding local community services e. Assess for potential to return to work