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

Middleton S. Dale S. McElduff B. Coughlan K. McInnes E. Mikulik R. Fischer T. Van der Merwe J. Cadilhac D. D’Este C. Levi C. Grimshaw J.M. Grecu A. Quinn C. Cheung N.W. Koláčná T. Medukhanova S. Sanjuan Menendez E. Salselas S. Messchendorp G. Cassier-Woidasky A.-K. Skrzypek-Czerko M. Slavat-Plana M. Antonella U. Pfeilschifter W.
March 2023 SAGE Publications Ltd

European Stroke Journal
2023 #8 Issue 1 132 - 147 pp.

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.

dysphagia , FeSS , fever , hyperglycaemia , implementation , nurses , QASC , Stroke , swallow , translation

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Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
International Clinical Research Centre, Neurology Department, St. Ann’s University Hospital and Masaryk University, Brno, Czech Republic
Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia
Sax Institute, Sydney, Australia
John Hunter Health and Innovation Precinct, HNE LHD, New Lambton, NSW, Australia
Department of Medicine, University of Newcastle, Callaghan, NSW, Australia
University of Ottawa, Ottawa, ON, Canada
Ottawa Hospital Research Institute, Ottawa, ON, Canada
Prince of Wales Hospital, Randwick, Australia
Centre for Diabetes and Endocrinology Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
Fakultní nemocnice Motol, Prague, Czech Republic
National Center for Neurosurgery, Nur-Sultan, Kazakhstan
Vall d’Hebron Hospital Universitari, Barcelona, Spain
ULSNE Macedo de Cavaleiros, Macedo de Cavaleiros, Portugal
University Medical Center Groningen, Groningen, Netherlands
Saarland University of Applied Sciences, Saarbrücken, Germany
Medical University of Gdańsk, Gdansk, Poland
Health Department, Agency for Health Quality and Assessment (AQuAS), CIBER Epidemiología y Salud Pública, CIBERESP, Stroke Programme, Barcelona, Spain
Hospital Network Area-Regional Health Department, Regione Lazio, Rome, Italy
Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
Department of Neurology, Goethe University, Frankfurt am Main, Germany

Nursing Research Institute
School of Nursing
International Clinical Research Centre
Angels Initiative
Stroke and Ageing Research
National Centre for Epidemiology and Population Health (NCEPH)
Sax Institute
John Hunter Health and Innovation Precinct
Department of Medicine
University of Ottawa
Ottawa Hospital Research Institute
Prince of Wales Hospital
Centre for Diabetes and Endocrinology Research
Fakultní nemocnice Motol
National Center for Neurosurgery
Vall d’Hebron Hospital Universitari
ULSNE Macedo de Cavaleiros
University Medical Center Groningen
Saarland University of Applied Sciences
Medical University of Gdańsk
Health Department
Hospital Network Area-Regional Health Department
Department of Neurology and Clinical Neurophysiology
Department of Neurology

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