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Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe): A pre-test/post-test implementation study
S. Middleton, S. Dale, B. McElduff, K. Coughlan, E. McInnes, R. Mikulik, T. Fischer, J. Van der Merwe, D. Cadilhac, C. D'Este, C. Levi, JM. Grimshaw, A. Grecu, C. Quinn, NW. Cheung, T. Koláčná, S. Medukhanova, E. Sanjuan Menendez, S. Salselas, G....
Language English Country England, Great Britain
Document type Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Stroke * diagnosis MeSH
- Fever diagnosis MeSH
- Hyperglycemia * diagnosis MeSH
- Humans MeSH
- Deglutition MeSH
- Deglutition Disorders * diagnosis MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Australia MeSH
INTRODUCTION: Poor adoption of stroke guidelines is a problem internationally. The Quality in Acute Stroke Care (QASC) trial demonstrated significant reduction in death and disability with facilitated implementation of nurse-initiated. METHODS: This was a multi-country, multi-centre, pre-test/post-test study (2017-2021) comparing post implementation data with historically collected pre-implementation data. Hospital clinical champions, supported by the Angels Initiative conducted multidisciplinary workshops discussing pre-implementation medical record audit results, barriers and facilitators to FeSS Protocol implementation, developed action plans and provided education, with ongoing support co-ordinated remotely from Australia. Prospective audits were conducted 3-month after FeSS Protocol introduction. Pre-to-post analysis and country income classification comparisons were adjusted for clustering by hospital and country controlling for age/sex/stroke severity. RESULTS: Data from 64 hospitals in 17 countries (3464 patients pre-implementation and 3257 patients post-implementation) showed improvement pre-to-post implementation in measurement recording of all three FeSS components, all p < 0.0001: fever elements (pre: 17%, post: 51%; absolute difference 33%, 95% CI 30%, 37%); hyperglycaemia elements (pre: 18%, post: 52%; absolute difference 34%; 95% CI 31%, 36%); swallowing elements (pre: 39%, post: 67%; absolute difference 29%, 95% CI 26%, 31%) and thus in overall FeSS Protocol adherence (pre: 3.4%, post: 35%; absolute difference 33%, 95% CI 24%, 42%). In exploratory analysis of FeSS adherence by countries' economic status, high-income versus middle-income countries improved to a comparable extent. DISCUSSION AND CONCLUSION: Our collaboration resulted in successful rapid implementation and scale-up of FeSS Protocols into countries with vastly different healthcare systems.
Angels Initiative Boehringer Ingelheim International GmbH Hamburg Germany
Department of Medicine University of Newcastle Callaghan NSW Australia
Department of Neurology and Clinical Neurophysiology Städtisches Klinikum Lüneburg Lüneburg Germany
Department of Neurology Goethe University Frankfurt am Main Germany
Fakultní nemocnice Motol Prague Czech Republic
Hospital Network Area Regional Health Department Regione Lazio Rome Italy
John Hunter Health and Innovation Precinct HNE LHD New Lambton NSW Australia
Medical University of Gdańsk Gdansk Poland
National Center for Neurosurgery Nur Sultan Kazakhstan
Ottawa Hospital Research Institute Ottawa ON Canada
Prince of Wales Hospital Randwick Australia
Saarland University of Applied Sciences Saarbrücken Germany
Sax Institute Sydney Australia
School of Nursing Midwifery and Paramedicine Australian Catholic University Sydney Australia
ULSNE Macedo de Cavaleiros Macedo de Cavaleiros Portugal
University Medical Center Groningen Groningen Netherlands
References provided by Crossref.org
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