The Quality in Acute Stroke (QASC) Europe Project is a nurse-led, evidence-based stroke care program to manage Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) difficulties in the first 72 hours after stroke. Seminal data from an Australian clinical trial demonstrated a significant (15.7%) 90-day reduction in death and dependency and a sustained (out to a median of 4 years) reduction in mortality when multidisciplinary stroke unit teams were assisted to implement the FeSS Protocols.

A unique international partnership has been established between the Nursing Research Institute (a joint collaboration between Australian Catholic University, St Vincent’s Health Network Sydney, and St Vincent’s Hospital Melbourne); the European Stroke Organisation; the Acute Networks Striving for Excellence in Stroke (ANGELS) Initiative; and the European Registry of Stroke Care Quality (RES-Q). This collaboration has enabled the evidence translation program to be implemented in 19 countries across Europe (Armenia, Belarus, Bulgaria, Czech Republic, Georgia, Germany, Italy, Kazakhstan, Lithuania, Macedonia, Moldova, Poland, Portugal, Romania, Russia, Slovakia, Spain, Uzbekistan and Ukraine). Many participating hospitals are from resource-limited countries that do not have access to the latest stroke therapies including thrombolysis medication nor thrombectomy. Hence, introduction of these evidence-based nursing care protocols will likely make a significant difference in reducing death and disability after stroke.

The project is managed from the Nursing Research Institute in Australia, with a part-time Project liaison officer based in the Netherlands. The Angel Initiative inform and create awareness about the QASC Europe Project to clinicians in their native language bridging the communication link between the hospitals and the Nursing Research Institute.

Data are entered by clinicians into the RES-Q database before and after implementation of the protocols. Hospitals are provided with summary reports on their compliance with the FeSS Protocols at completion of both the pre and post-implementation phases. To date, we have 98 enrolled hospitals from 17 countries, with 66 hospitals currently entering data (n=4000 patients to date). Forty six have completed baseline data entry, with implementation commenced at 32 hospitals. Nine hospitals have completed their post-implementation data collection and, encouragingly, all have shown improvements in at least one or more of the fever, hyperglycaemia and swallowing elements of the protocol.

This global collaborative model of implementation is designed to maximise the potential of the nursing stroke healthcare workforce to improve patient outcomes. A crucial legacy this Project will leave is raising awareness amongst nurses about how to critically examine their clinical practice and how to conduct quality improvement initiatives that can extend beyond the current project. Many of our collaborating nurses have not previously participated in or led a local quality improvement study. All of the hospitals (n=5) who had completed the Project at the time were supported by the Nursing Research Institute to submit abstracts to the 2020 European Stroke Conference and all were accepted for a poster. In most participating countries, we also have been able to identify a nurse who is the designated QASC Europe Country Coordinator available to hospitals for technical advice and representing nurses from their country on the QASC Europe Project Steering Committee.

This Project is an excellent example of industry and academia collaboration. Furthermore, in the 2020 International Year of the Nurse and in line with the World Health Organisation’s ‘Nursing Now’ campaign, this Project is empowering nurses to maximise their contribution to improving health globally.


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