Lege Artis Medicinae

[Evidence-based practice guidelines for nursing and rehabilitation of stroke patients]

BALOGH Zoltán

JANUARY 20, 2003

Lege Artis Medicinae - 2003;13(01)

[Stroke is a common problem, being the third most frequent cause of death in the United Kingdom and Hungary, accounting for about 20% of bed occupancy. It is also an important cause of morbidity and disability mainly for those aged over 65. As a result, stroke care constitutes as an important part of health services use. Home care services working in the field of stroke rehabilitation have not used a unified evidence-based approach and well-described professional principles and protocols. There was little cooperation between the teams working in the institutional rehabilitation and home care rehabilitation services. No agreed rehabilitation processes, and standardised scales and documentation, showing the change of quality of life, were in use. There were no quality indicators and efficiency measures of nursing and no provision of services either. The Hungarian Nursing Association played a pioneering role in the introduction and dissemination of Evidence Based Nursing in Hungary and in adopting it into routine clinical practice. The successful implementation of the Association's project could be a good example for another field of care and nursing in Hungary and other countries in Europe. Our projects are supported by the Department For International Development (UK) in the framework of the TUDOR project. The Hungarian Nursing Association (HNA) developed a postgraduate training programme entitled "Evidence based nursing in practice". The participants were required to be members of the HNA, have a degree in the field of nursing (nurse teacher, degree nurse, nurse director). Members of the target group were all working in the field of stroke rehabilitation at hospitals or out-patient clinics and home nursing. The Hungarian Nursing Association's professional group developed an evidence based practice guideline for rehabilitation of stroke patients, which was published in the Bulletin of the Ministry of Health (11/2002, 23rd May, 2002). These evidence-based stroke rehabilitation guidelines focused on bladder management, position therapy and patient information.]

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[The unacceptable results of laboratory testing derive from the insufficient preanalytical, analytical and postanalytical processes. In addition to the analytical errors, there are inappropriate testing orders which reflect the failures of diagnostic strategy, and either result in excess testing orders without additional new informations, or in the lack of testing order that would be necessary for efficiency of patient's care. An increasing number of study demonstrate that in majority of cases the cause of erroneous results can be traced back to mistakes in the preanalytical phase (preparation of patient, sample collection). The total quality of the diagnostic strategy depends both on the compliance of tests according to the health condition of patient and the quality performance of laboratory processes. The elimination of the preanalytical errors and the formulation of proper diagnostic strategy requires a close cooperation between physicians and the diagnostic workplaces as well as the application of multidisciplinary guidelines which specify the quality requirements of the whole diagnostic process. Such guidelines are not prepared for specific professional activities and do not replace lower-level professional standards (e.g. for test procedures). Based on evidence-based medicine and the recommendations of international experts such guidelines should cover all elements of quality assurance necessary to achieve efficient diagnostic strategy and testing. There is little doubt that such recommendations will also be useful for rational financing of the health care system.]

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[Despite the insufficient financial support, the number of the laboratories for sleep diagnostics and the examined patients are rising. The CPAP (Continuous Positive Airway Pressure) equipment playing the main role in the treatment of the obstructive sleep apnoe syndrome (OSAS) is recently available from three neurological centres (Budapest, Debrecen, Pécs). These centres can prescribe the machine as a ”model experiment” with 85% support given by the State Health Care. The increase of the number of the licensed hospitals is expected in the near future, the only condition is the polysomnography background. Differential diagnostics (narcolepsy, RLS, PLMS, sleepdependent laryngospasm, disorders of the circadian rhythm) and the follow-up of the CPAP using patients (indication, contraindication, compliance, CPAP pressure setting, CPAP therapy control) have been emphasized.]

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