TY - JOUR
T1 - Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe)
T2 - A pre-test/post-test implementation study
AU - Middleton, Sandy
AU - Dale, Simeon
AU - McElduff, Benjamin
AU - Coughlan, Kelly
AU - McInnes, Elizabeth
AU - Mikulik, Robert
AU - Fischer, Thomas
AU - Van der Merwe, Jan
AU - Cadilhac, Dominique
AU - D’Este, Catherine
AU - Levi, Christopher
AU - Grimshaw, Jeremy M.
AU - Grecu, Andreea
AU - Quinn, Clare
AU - Cheung, Ngai Wah
AU - Koláčná, Tereza
AU - Medukhanova, Sabina
AU - Sanjuan Menendez, Estela
AU - Salselas, Susana
AU - Messchendorp, Gert
AU - Cassier-Woidasky, Anne Kathrin
AU - Skrzypek-Czerko, Marcelina
AU - Slavat-Plana, Merce
AU - Antonella, Urso
AU - Pfeilschifter, Waltraud
N1 - Publisher Copyright:
© European Stroke Organisation 2022.
PY - 2023/3
Y1 - 2023/3
N2 - 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.
AB - 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.
KW - FeSS
KW - QASC
KW - Stroke
KW - dysphagia
KW - fever
KW - hyperglycaemia
KW - implementation
KW - nurses
KW - swallow
KW - translation
UR - http://www.scopus.com/inward/record.url?scp=85140757351&partnerID=8YFLogxK
U2 - 10.1177/23969873221126027
DO - 10.1177/23969873221126027
M3 - Article
SN - 2396-9873
VL - 8
SP - 132
EP - 147
JO - European Stroke Journal
JF - European Stroke Journal
IS - 1
ER -