Quality in acute stroke care (QASC) Germany project: improving efficiency in stroke units with nurseinitiated protocols to manage fever, hyperglycemia and swallowing poststroke.

Abstract

Background and aims: Assisted implementation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing (FeSS) following stroke significantly reduces 90-day death and disability. An international collaboration, between Nursing Research Institute, Australian Catholic University; European Stroke Organisation; Saarland University of Applied Sciences; and Interdisciplinary NeuroVascular Network Rhein-Main; aimed to implement the FeSS protocols into German stroke units. Method(s): This multi-centre, pre-test/post-test study was conducted between 2020-2022. Data were collected using REDCap at baseline and three months post-implementation. Nurses, with project team support, conducted multidisciplinary facilitator workshops, developed action plans and conducted education sessions. Result(s): Data from eight INVN-hospitals was obtained for 771 patients (baseline), and 679 patients (post-implementation) (n=1450). There were significant improvements in treatment with anti-pyretics for first temperature >37.5degreeC (Pre 35%; Post 67%, p<0.0001); blood glucose monitoring on day of admission (Pre:77%; Post:78%, p 0.0007); day two of admission (Pre: 53%; Post:70%, p<0.0001); treatment with insulin for first episode of hyperglycaemia BGL >=200mg/dL (Pre:48%; Post:66%, p<0.0080) and within one hour of first BGL >=200mg/dL (Pre:76%; Post:90%, p<0.0001); number of formal swallow screens performed (Pre:69%; Post:75%, p<0.0001) and number performed within 24 hours of admission (Pre:91%; Post:98%, p<0.0308). Conclusion(s): While German stroke units report high standards of stroke care, these findings demonstrate that the introduction of nurseinitiated FeSS protocols supported by implementation science strategies, increased uptake of evidence-based care for the common post stroke complications of fever, hyperglycaemia and swallowing difficulties. The next challenge is to maintain these improvements to ensure that benefits to stroke patients are sustained.