Introduction
Stroke is the third commonest cause of death in Scotland; It is a
leading cause of disability and causes a greater range of disabilities
than any other.2 In Scotland stroke is a national
clinical priority and is supported by a suite of evidence based clinical
standards aimed at promoting continual improvements to care. Performance
is monitored both locally and nationally by the Scottish Stroke Care
Audit (SSCA).
Based on emerging evidence of the most important drivers for improving
stroke outcomes in 2014 the Scottish Government introduced a national
stroke ‘bundle of care’.3 In 2016 the SSCB standard
was introduced4 with the aim that “80% of all
patients admitted to hospital with a diagnosis of stroke should receive
the appropriate elements of the stroke care bundle.” To date no Health
Board has managed to consistently achieve this target with the latest
published information showing a national average of 68%
attainment.5
A literature review was undertaken to underpin the study, but no
evidence was found which related to the barriers or enablers to the
implementation of the SSCB. Identification of local enablers and
barriers was identified as potentially valuable for informing
improvement activities relating to compliance with the SSCB, so the aim
of the study was to explore and describe the reasons why medical and
nursing staff in one Scottish Health Board area felt that the SSCB was
not being applied in a consistent and reliable way