Stories: Voices from the frontline
Katie Lytwyniuk, RN
Residents of the Puget Sound region know they can rely on Swedish Cherry Hill to provide exceptional care in the event of a stroke. From emergency department nurses to neurosurgeons to physical therapists, our team is there for them from the minute they come through our doors and throughout recovery. It’s one reason we’re a Comprehensive Stroke Center, the highest rating awarded by accreditation firm DNV GL.
Now we’re adding another layer of support. Last fall Katie Lytwyniuk, RN, joined our team as nurse navigator to ensure patients receive high-quality care after their discharge as well. We asked her how she helps these patients when they’re at their most vulnerable.
What does a nurse navigator do for patients who’ve had a stroke?
The most important thing is helping them set up the various follow-up appointments they’re going to need. So within 24 to 48 hours after a patient is discharged home or to home health—which can include speech, occupational and physical therapy—I’ll call them to guide them through that process with their primary care doctor and with someone from our stroke clinic at Cherry Hill or Issaquah. If they live outside of the area, I’ll help get them referrals to a neurologist closer to them.
The first thing I ask them, though, is whether they’re having any new signs or symptoms of stroke. I’ll also talk to them about their current medication regimen and make sure they’ve picked up their prescriptions and understand their discharge instructions.
We also have a support group for patients who have had a stroke and their family members. It meets the third Monday of the month. I try to have a different guest speaker every month; in January it will be someone from the American Stroke Association. It’s just a nice opportunity for patients to meet and talk to others who know what they’re going through.
How long do you follow these patients?
Just through that first 24 to 48 hours after discharge. So that’s why making sure they get set up for follow-up appointments is so important. Once you’ve had a stroke, you’re more likely to have another stroke down the road, especially if you don’t make certain changes to your lifestyle. So the other part of my job, which I’m hoping to start this month, is sitting down with our highest risk patients before they’re discharged to go over a stroke risk management plan.
And what is that?
So 80% of strokes are preventable. And there are several risk factors, including high blood pressure. It’s the silent one; most people don’t know they have it until they go to the doctor for something else or check it at Walgreens. Then there are others, like atrial fibrillation, smoking, diabetes, high cholesterol, having a BMI over 25, physical inactivity and excessive alcohol consumption.
All of those factors go into determining a patient’s LACE+ score, a readmission risk scoring system. Our system will automatically flag patients who have a high LACE+ score, so before they’re discharged, I’ll sit down with them and discuss their risk factors and what they can do to reduce them. What will really help, though, is the worksheet that shows them their numbers—like cholesterol and blood pressure—and explains all of them in layman’s terms. It’s all written out in plain English.
So we’ll talk about what changes they need to make to reduce their chances of another stroke, and for these patients specifically I’ll work with them to schedule their follow-up appointments before they’re discharged.
Besides just saying “You need to make these changes,” how do you express to patients the gravity of the situation?
It's hard. I’ve had patients who just don’t want to talk to me. They don’t care. In those cases it helps to talk to family members—whether it be their significant other, their children, their second cousin—and educate them, too. They can be that trusted voice that says, “Hey, we want you to stick around. We love you, and we need you to take care of yourself.”
But then a lot of patients I have talked to have been just terrified. I spoke to one patient yesterday who said they got home and threw out all of their junk food; they just tossed it right in the garbage and threw it outside in their bin. They're like, “I am starting fresh. I do not want to have another stroke. I want to live.”
Are these patients in the right frame of mind for these conversations after just having a stroke?
You know, a lot of them are not. They’ve just had a brain injury, and then all of this information is coming at them. It can definitely be overwhelming. That’s another reason it’s important to have that second person there with them—whether it’s a family member or friend—to help them digest the information. Having that second set of eyes and ears is key. I can’t imagine having a stroke and then trying to navigate all of this without someone there to help me.
With your experience, you’ve probably seen patients make some amazing recoveries.
Yeah, at Mayo I saw patients who suffered horrible strokes. Obviously it depends on how bad their stroke was, but it can be an incredibly frustrating experience, especially if they’re experiencing speech difficulties or trouble with fine motor skills. They try to say something or write something and it comes out all jumbled.
But I also got to see them improve and transition through their care. And maybe a year later, after they’d been to rehab, they would come back to visit, and it’s like they’re a completely different person. They’re walking and talking. It’s amazing. It melts your heart.
For more information on how you can support our stroke program or to make a gift, please contact us at 206-386-2738 or [email protected].