Abstract 2954: Evaluating the Retention of Stroke Education Provided to the Hospitalized Patient with Acute Ischemic Stroke in an Urban Hospital

Abstract

Background and Purpose: The Joint Commission mandates that certified Primary Stroke Centers provide patient education addressing stroke warning signs, use of 911 for access to emergent care, personal risk factors, medications prescribed, and follow-up after discharge. The patient’s retention of this information is imperative for reducing secondary stroke occurrence and morbidity. This study evaluated the Acute Ischemic Stroke (AIS) patient’s ability to retain the stroke education information provided near the time of hospital discharge. Methods: A prospective hospital-based cohort study was comprised of AIS patients who were admitted to the stroke unit at an urban core hospital located in Jacksonville, Florida. Diagnosis of AIS was confirmed by a Neurologist and by a CT or MRI. All participants received Joint Commission mandated stroke education administered by a nurse during their hospitalization. The patient education included verbal instructions with the use of illustrative handouts. Stroke education retention was evaluated near the time of hospital discharge using a five-question survey. The level of health literacy was assessed by the Short Version-Test of Functional Health Literacy in Adults (S-TOFLHA). Results: Of 189 consecutive patients screened between October 2009 and June 2010, 100 (53%) consented to participate. Seventy patients were excluded due to severe cognitive impairment, and 18 eligible patients refused to participate. The average age was 60 years old, 57% were male, 56% African American, 43% resided within the urban core, and 75% earned less than $25,000 per year. A total of 59% of patients had low to marginal health literacy. Retention of stroke knowledge was lacking even with standard stroke post education; 12% could name all 5 warning signs, 43% knew their personal risk factors, 85% knew to call 911 for warning signs of stroke, 76% knew their medications prescribed for stroke prevention, and 53% knew their type of stroke. Conclusion: Current methods of educating hospitalized AIS patients may not adequately prepare the hospitalized stroke survivor with basic knowledge on stroke prevention. Alternative methods of education will need to be developed for AIS patients in urban core hospitals. By using the Patient-Centered Care model and principles of adult learning, this study has the potential to lead to changes in educational interventions, nursing practices, and communication.