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