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					Stroke Care Clinical Network
Consumer Report
January 2009



Welcome
Welcome to the January newsletter
for the Department of Human Services,
Victorian Stroke Clinical Network (VSCN).
2009 marks the commencement of the VSCN
second year and we look forward to bringing
you all the latest and exciting developments.

National Stroke Week
15-21 September

                                                 Health Minister Daniel Andrews promoting the
                                                 dial 000 message

                                                 ‘FAST’ educates people to identify the signs of
                                                 stroke and the need for FAST action.




Professor Chris Bladin with Kim Durose and
her husband Matt

The 2008 Stroke Week has been a success
and health services are using this as an
opportunity to highlight their stroke services
and raise the profile of stroke and its risk
factors in their local community. Once again
the VSCN has provided the National Stroke
Foundation (NSF) with $300,000 to augment
its mass media ‘FAST’ campaign in Victoria to
enhance public awareness of the signs and
symptoms of stroke, and emphasize the
message that stroke is a medical emergency.
The Minister for Health launched Victoria’s
Stroke Week on 16 September 2008 at the
invitation of the Stroke Foundation.




www.health.vic.gov.au/clinicalnetworks
Department of Human Services
Similar funding was provided to the NSF in       1. Have knowledge of their condition.
2007 and resulted in Victorians having           2. Follow a care plan agreed with their health
greater exposure to the television, radio           professionals.
and print media campaign than other states.      3. Actively share in decision making with
The Victorian public received up to six times       health professionals.
more exposure to the FAST campaign than          4. Monitor and manage signs and symptoms
NSW residents, and over five million                of their condition.
Victorians were reached, in some form by this    5. Manage the impact of the condition on
important public health message. Evaluation         their physical, emotional and social life.
of the 2007 campaign demonstrated that the       6. Adopt lifestyles that promote health.
Victorian public were more able to correctly
identify the signs of stroke, and correctly      Self management programs are for people
name two symptoms of stroke than the             with chronic disease and generally operate
national average. 89 percent of Victorians       in a community health setting by specially
surveyed correctly responded they would call     trained chronic disease workers. A number
000 if a stroke was suspected.                   of self management models exist and
                                                 evidence clearly demonstrates the
Stroke support groups                            effectiveness of these programs with
                                                 improved health outcomes, improved levels
During Stroke Week, Adele Mollo (VSCN
                                                 of self-efficacy and improvement in quality of
Stroke Facilitator Team Coordinator) and Sally
                                                 life. Unfortunately many stroke survivors with
Daff had the pleasure of meeting the
                                                 cognitive problems and/or those with severe
Boroondara Stroke Support Group at their
                                                 disabilities may not necessarily have the
September meeting. Adele gave an excellent
                                                 same improved outcomes. With this in mind,
consumer presentation on the Stroke Clinical
                                                 the working party is exploring options of
Network and the Stroke Strategy. Members
                                                 stroke specific self management programs
were most interested in the progress of the
                                                 that may better suit the needs of stroke
VSCN and feedback suggests that members
                                                 survivors.
are very keen to have regular updates.
During Stroke Week, Boroondara Stroke
                                                 Generic Chronic Disease Self Management
Support Group launched their new Stroke
                                                 programs are often available through
Support Group Information Pack for members
                                                 Community Health services. To find out more
in the Boroondara area. Congratulations
                                                 contact your local community health service
to this active and dedicated committee on this
                                                 or ask your GP if there is a suitable program
well researched and quality publication.
                                                 available near you. The SCN will keep you
                                                 informed on developments in stroke specific
Stroke Clinical Network Sub                      chronic disease self management programs.
Committees
Within the VSCN, speciality subcommittees        Stroke Network facilitator report
and working parties has been established to      Each newsletter we hope to give you a
address specific issues within the               snapshot on developments from the Stroke
recommendations of the stroke care strategy.     Network Facilitators. This months report is
One of these groups is the Consumer Working      from the Loddon Mallee Region -
Party. This working party has noted the key      incorporating Bendigo Health.
findings on patient and carer needs and as a
result is addressing recommendations 22 and      The Loddon Mallee region is situated in the
25 in the strategy.                              North-west of Victoria and extends from
                                                 Mildura in the far north, to the Macedon
One component of Recommendation 25 is            Ranges in the south. It is the largest
promoting self management programs for           geographical DHS region in Victoria,
long term care of the patient. You may ask       encompassing a quarter of the state. It has a
what self management is and what are self        population of over 307,000, approximately
management programs? Self management is          15% of which are over 65 years of age.
about people being actively involved in their
own health care. There are six recognised
principles of self management:



www.health.vic.gov.au/clinicalnetworks
Department of Human Services
Bendigo Health is the regional tertiary health   The Stroke Unit trial is set to begin early next
and referral service for the Loddon Mallee       year, and the Thrombolysis documents are
Region, and is located 145km from                being prepared for final submission to the
Melbourne. It has approximately 3,100            Clinical Standards Group meeting.
employees across acute, sub-acute,               Work surrounding the introduction and
community and continuing care, spread            trialling of a Dysphagia Screening tool is
across 11 cities and towns. Last year, Bendigo   progressing in collaboration with both Medical
Health had almost 30,000 separations for a       and Speech Pathology services. There is an
total of 211,880 bed days, and the               enthusiastic multi-disciplinary team at
emergency department handled over 43,000         Bendigo Health who are keen to optimise the
presentations, an 11% increase from the          suite of available stroke services, not only
previous year. The latest department data        locally but across the region.
reveals that Loddon Mallee has over 600
stroke cases per year. In the last financial     The process of assisting health services
year over half of these presented to the         to evaluate current stroke service provision,
emergency department at Bendigo Health,          capacity and demand is currently being
resulting in 240 cases being admitted.           undertaken by the Stroke Network Facilitators
                                                 across the Loddon Mallee region. Thus far,
In May 2008, two Stroke Network Facilitators     Kerang and Swan Hill have been engaged
were appointed to the Loddon Mallee region.      in this process. The next health services
As part of their role at Bendigo Health, a       to be engaged include Echuca and Cohuna,
collaborative analysis of available stroke       with further health service visits planned
services was undertaken; this highlighted the    for the New Year to further this evaluation
strengths, and opportunities for development,    process. As a part of this process a Region
of stroke services within this facility. Two     wide Stroke Steering Committee will
committees have been convened to develop,        be formed with representation from each
prioritise and implement work plans to           health service in the region.
optimise Stroke Services across Bendigo
Health. The key priority areas identified        Dysphagia Screening Project
through this process include:
                                                 Dysphagia (difficulty in swallowing) is
1. Development of policies and procedures        common after stroke and is frequently
   governing the use of thrombolysis for         associated with increased risk of
   ischemic stroke patients.                     complications such as aspiration pneumonia,
2. Development and introduction of a             airway obstruction, dehydration and
   sustainable stroke unit model of care,        malnutrition. Early identification is important.
   directed by the National Stroke               The National Stroke Foundation Clinical
   Foundation guidelines and current literary    Guidelines for Acute Stroke Management
   evidence.                                     (2007) states that patients should be
3. Development of an evidence-based              screened for swallowing difficulties before
   assessment and management plan for TIA        being given food, drink or oral medications.
   presentations and admissions.                 Screening should be undertaken by personnel
4. Collaboration and cohesion across the         specifically trained in swallowing screening.
   continuum of care.                            The aim of the VSCN Dysphagia Screening
5. An out-of-hours Dysphagia screening           Project is to review current practices,
   service.                                      benchmark against national practices
                                                 and develop a model for a consistent
                                                 approach to dysphagia screening across
                                                 Victoria that is in line with best evidence care.




www.health.vic.gov.au/clinicalnetworks
Department of Human Services
A survey investigating current practice with     Stoke Palliative Care Project
dysphagia screening for acute stroke patients    This project (with a Commonwealth grant)
has been conducted across the state.             aims to improve access to palliative care for
A response rate of 76 percent was achieved.      people who have had a stroke and their
Only 32 percent of health services report        carers. Project partners include; Melbourne
conducting dysphagia screening. Out of the       Health, Melbourne City Mission, the West
health services that do conduct dysphagia        Metropolitan Palliative Care Consortium and
screening the type of tools used vary widely     DHS (Cancer and Palliative Care Unit & VSCN).
and only a small proportion use validated
tools. For those health services not             Melbourne Health palliative care consultancy
conducting screening many significant            team recently recruited a Stroke Palliative
barriers and issues were reported that           Care Research Nurse to manage the palliative
constrain its implementation.                    care/stroke project. We will provide further
A detailed analysis of the data along with the   updates as the project develops.
project plan is currently in development.
The department is also forming a Dysphagia       Website
Screening Steering Committee and a working       The Victorian Stroke Clinical Network has a
party to support the development of a model      new website. To find out all the latest news
for a consistent approach to dysphagia           and developments go to
screening across Victoria. Please feel free to   www.health.vic.gov.au/clinicalnetworks/
ask any questions by emailing Linda Francis      stroke
at Linda.Francis@dhs.vic.gov.au.
                                                 Sally Daff
                                                 Consumer Representative
                                                 Stroke Clinical Network




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(03) 9096 1327 using the National Relay Service 13 36 77 if required, or email
clinicalnetworks@dhs.vic.gov.au

This document is also available in PDF format on the internet at
www.health.vic.gov.au/clinicalnetworks




www.health.vic.gov.au/clinicalnetworks
Department of Human Services