Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe): A pre-test/post-test implementation study

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 protocols to manage fever, hyperglycaemia and swallowing (FeSS Pr...

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Bibliographic Details
Published in:European stroke journal 2023-03, Vol.8 (1), p.132-147
Main Authors: Middleton, Sandy, Dale, Simeon, McElduff, Benjamin, Coughlan, Kelly, McInnes, Elizabeth, Mikulik, Robert, Fischer, Thomas, Van der Merwe, Jan, Cadilhac, Dominique, D’Este, Catherine, Levi, Christopher, Grimshaw, Jeremy M, Grecu, Andreea, Quinn, Clare, Cheung, Ngai Wah, Koláčná, Tereza, Medukhanova, Sabina, Sanjuan Menendez, Estela, Salselas, Susana, Messchendorp, Gert, Cassier-Woidasky, Anne-Kathrin, Skrzypek-Czerko, Marcelina, Slavat-Plana, Merce, Antonella, Urso, Pfeilschifter, Waltraud
Format: Article
Language:English
Subjects:
Australia
Deglutition
Deglutition Disorders - diagnosis
Fever - diagnosis
Humans
Hyperglycemia - diagnosis
Original s
Stroke - diagnosis
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Summary: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 protocols to manage fever, hyperglycaemia and swallowing (FeSS Protocols) following stroke. We aimed to determine real-world effectiveness of supported implementation of the FeSS Protocols across Europe. 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 
ISSN:2396-9873
2396-9881
DOI:10.1177/23969873221126027