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. 2023 Mar;8(1):132-147.
doi: 10.1177/23969873221126027. Epub 2022 Oct 24.

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

Sandy Middleton  1   2 , Simeon Dale  1   2 , Benjamin McElduff  1   2 , Kelly Coughlan  1   2 , Elizabeth McInnes  1   2 , Robert Mikulik  3 , Thomas Fischer  4 , Jan Van der Merwe  4 , Dominique Cadilhac  5 , Catherine D'Este  6   7 , Christopher Levi  8   9 , Jeremy M Grimshaw  10   11 , Andreea Grecu  3 , Clare Quinn  12 , Ngai Wah Cheung  13 , Tereza Koláčná  14 , Sabina Medukhanova  15 , Estela Sanjuan Menendez  16 , Susana Salselas  17 , Gert Messchendorp  18 , Anne-Kathrin Cassier-Woidasky  19 , Marcelina Skrzypek-Czerko  20 , Merce Slavat-Plana  21 , Urso Antonella  22 , Waltraud Pfeilschifter  23   24
Affiliations

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

Sandy Middleton et al. Eur Stroke J. 2023 Mar.

Abstract

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.

Keywords: FeSS; QASC; Stroke; dysphagia; fever; hyperglycaemia; implementation; nurses; swallow; translation.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SD, SM and RM received speakers’ fees, conference registration and travel expenses from the Angels Initiative. Other authors have no competing interests.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
QASC Europe project flow diagram.
See this image and copyright information in PMC

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