An evidence-based proposal: implementing the 'BEFAST' stroke screening tool for improved prehospital detection of posterior circulation stroke

Godley, Nicola ORCID: https://orcid.org/0009-0008-1745-3272 (2022) An evidence-based proposal: implementing the 'BEFAST' stroke screening tool for improved prehospital detection of posterior circulation stroke. Masters dissertation, University of Cumbria. Item availability may be restricted.

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Abstract

Acute stroke is the leading cause of death and disability, affecting over 100,000 people and the cause of 80,000 deaths within the United Kingdom (UK) each year (NICE, 2022a). Posterior circulation stroke (PCS) represents up to 25% of ischaemic strokes (Banerjee et al., 2018; Merwick and Werring, 2014) and is linked to increased long-term disability and a greater risk of death (Pickham et al. 2019). Current clinical guidelines (JRCALC & AACE, 2019; NICE, 2019) recommend the use of a validated stroke screening tool, such as the ‘FAST’ stroke screening tool (DoH, 2009) for the assessment of all patients with stroke symptoms. However, PCS signs and symptoms present differently to the ‘classical’ acute stroke symptoms, for which the 'FAST’ test does not account for or accurately identify (Chen et al. 2022; Krishnan et al. 2019; Sommer et al. 2017). Recent changes to practice have occurred within American clinical guidelines, following research conducted surrounding the ‘BEFAST’ (Balance, Eyes, Face, Arms, Speech, Time) stroke screening tool (Aroor et al. 2017), which identified that the addition of balance and eye assessments to the ‘FAST’ stroke screening tool (DoH, 2009) improve the detection of PCS symptoms.

This dissertation explores an evidence-base change to practice to implement a new clinical guideline through a local pilot project, utilising the ‘BEFAST’ stroke screening tool (Aroor et al. 2019), for the improved pre-hospital detection of patients presenting with PCS. A literature review was undertaken with several themes extrapolated from the literature for discussion, identifying key information and bolstering the rationale for the proposed change. Topics include the need to change from ‘FAST’ to ‘BEFAST’, the additional assessments for inclusion within the new clinical guideline and the types of paramedic education required within the project. This project is representative of a complex change initiative, Kotter’s eight-step model (1986) and Deming’s PDSA cycle (1983) were both applied, including suggested change management tools, throughout the change and evaluation strategy proposed. The work undertaken so far will be presented to the local ambulance service senior management for consideration of the stated change initiative to improve prehospital management of acute stroke patients. Through the implementation of this project within the local ambulance service, and the improved training and awareness of paramedics in the signs and symptoms of PCS, it is hoped that the number of misdiagnosed PCS within the pre-hospital environment will be reduced and will improve patient management and outcomes.

Item Type:	Thesis/Dissertation (Masters)
Departments:	Institute of Health > Centre for Excellence in Paramedic Practice
Additional Information:	Submitted and passed as dissertation for MSc Paramedic: Advancing Practice at University of Cumbria, July 2022, word count: 8,703.
Depositing User:	Nicola Godley
Date Deposited:	21 Mar 2023 16:30
Last Modified:	13 Jan 2024 13:33
URI:	https://insight.cumbria.ac.uk/id/eprint/6992