Approximately 15 million people worldwide suffer a stroke each year (1). There is compelling evidence that improved patient outcomes are achieved through early intervention in acute stroke care including thrombolysis, endovascular clot retrieval (2) and access to specialised in-patient stroke units (3). Hyperglycaemia, swallowing dysfunction and elevated temperature are physiological variables known to be associated with poorer stroke outcomes (4-7). Optimal management of fever, hyperglycaemia and dysphagia have been identified in international guidelines as priorities for inpatient stroke management (8-10).
The Quality in Acute Stroke Care (QASC) Trial demonstrated that multidisciplinary, nurse-led interventions to manage fever, hyperglycaemia and swallow difficulties following acute stroke significantly improved health outcomes. Results showed that supported implementation of the Fever, Sugar, Swallow (FeSS) clinical protocols resulted in 16% decreased death and dependency at 90-days, and in-hospital: reduced mean temperatures, reduced mean glucose levels and improved swallow screening management. There also was a non-significant reduction in length of stay by two days (11). Results were fast-tracked for publication in The Lancet, with a commentary, winning the Canadian Stroke Congress Award for Impact in 2011 and the 2012 American Heart Association Council on Cardiovascular Nursing Stroke Article of the year.
In 2014, the New South Wales (NSW) Agency for Clinical Innovation partnered with the Nursing Research Institute, a joint initiative between St Vincent’s Health Australia (Sydney) and Australian Catholic University, to conduct a translational quality improvement project to implement the FeSS clinical protocols in all 36 Stroke Services throughout New South Wales (NSW). Our clinical translational initiative, the QASC Implementation Project (QASCIP), targeted stroke services to embed the FeSS Protocols into routine practice. Clinical site champions attended a one-day multidisciplinary training workshop, received standardised educational resources and ongoing support. Patient data were collected by self-reported retrospective medical record audits for up to 40 consecutive stroke patients per site both pre-and post-QASCIP (n=2144 patients). The FeSS protocols were successfully implemented resulting in significantly increased proportion of patients receiving care according to the protocols.
For more information, please contact:
Project Director, Professor Sandy Middleton RN PhD, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Sydney, Australia
In collaboration with the Nursing Research Institute St.Vincent’s Health Australia, Sidney – Australian Catholic University and in collaboration with the Boehringer-Ingelheim Angels Initiative.