Gaps in stroke service tackled
Stroke patients in Marlborough are not receiving the necessary care laid down in national guidelines.
The service in Marlborough lacks rehabilitation teams, proper dysphagia or swallow assessments for patients and an efficient referral system between GPs and Blenheim's Wairau Hospital to prevent early attacks leading to full-blown strokes.
Nelson Marlborough District Health Board older person health manager Jane Large said a review of the service was ongoing and that the board was working to bring the service into line with the National Stroke Clinical Network guidelines for New Zealand.
About 50 people were admitted to Wairau Hospital every year with a stroke, she said.
Between 100 and 120 people a year were admitted to Nelson Hospital.
"There are things that need to be done but we know what they are and have plans for many of them," Mrs Large said.
Wairau Hospital didn't have the staff to provide a community rehabilitation team, which was available to patients in Nelson.
The rehab team played a vital role in helping patients to develop the skills and functions needed to remain at home.
The various disciplinary teams within the hospital setting, such as physiotherapists, occupational therapists and speech language therapists, didn't have time to meet regularly and discuss treatments.
"All the teams are there but they don't have time to work together because they have so many other demands. They are spread between all the outpatients and inpatients."
An inter-disciplinary team was important in terms of monitoring a patient's progress.
Wairau Hospital didn't have a permanent on-site speech language therapist to carry out swallowing checks, Mrs Large said.
A stroke victim with a weakened swallow could be at risk of swallowing food into their lungs.
The board was looking at a six to eight-week training programme for nurses so they could carry out swallow assessments.
A better referral system between GPs and hospitals was needed to prioritise patients who had a transient ischaemic attack.
Nearly a third of transient ischaemic attacks, which was like an angina of the brain, led to full-blown strokes.
Wairau Hospital also didn't have a lead stroke nurse as recommended by the National Stroke Clinical Network guidelines, which were compiled by a team of experts in 2010.
However, the region did have a lead stroke clinician, Dr Andrew Wilson, who was very hands-on with patients due to a smaller number in Marlborough compared to Nelson.
Strokes were caused by either a blood clot, about two-thirds of cases, or through a burst artery, Mrs Large said.
The board provided a good thrombolysis, or clot busting, service comparable to the Canterbury District Health Board.
Thrombolysis was the preferred treatment for those patients that could benefit from the drug, which had to be administered within four hours of the stroke.
"We audit every case that comes through [the hospital] from onset to needle to make sure the right people get the medication they need."
An implementation plan for the national guidelines was finalised last year and showed health boards what they needed to focus on and how to achieve best practice.
The plan aimed to provide a better, more consistent stroke service across New Zealand.
"We have a team of people who are passionate about making sure we are delivering every area of our service up to the [standard of the] guidelines."
- The Marlborough Express