Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial
The Lancet, Early Online Publication, 12 October 2011
doi:10.1016/S0140-6736(11)61485-2Cite or Link Using DOI

Panel 2
Fever, sugar, swallowing (FeSS) intervention elements
Clinical treatment protocols for FeSS management by nurses for first 72 h of acute stroke unit (ASU) care: key elements
Temperature monitored and charted every 4 h after admission to ASU for first 72 h.
Temperature ≥37·5°C treated with paracetamol (intravenous, per rectum, or oral), unless clinically contraindicated.

Sugar (hyperglycaemia)
Formal glucose measured (venous blood not finger prick) on admission to hospital or admission to the ASU.
Finger-prick blood glucose on admission to ASU.
Finger-prick glucose every 1—6 h for first 72 h following ASU admission depending on previous blood glucose value.
On admission, if blood glucose between 8 mmol/L and 11 mmol/L and patient is diabetic, or between 8 mmol/L and 16 mmol/L and patient is not diabetic, start saline infusion for 6 h.
If, at any time in first 48 h after admission, blood glucose ≥11 mmol/L and patient is diabetic, or blood glucose ≥16 mmol/L and patient is not diabetic, start insulin infusion.

Nurses underwent an education programme about dysphagia screening, which consisted of all nurses attending an in-service given by the speech pathologist using a DVD prepared specifically for this study.
Nurses underwent a competency assessment before being able to screen patients, consisting of a pre-education and post-education written knowledge test, and a clinical competency test, completed on three patients and assessed by a speech pathologist.
Patients were screened with the ASSIST tool by either a nurse who passed the competency test or a speech pathologist within 24 h of admission to ASU; the result of the screening was clearly documented in the patient's medical record by use of a sticker.
Patients who failed the swallowing screening were referred to a speech pathologist for a swallowing assessment.

Site-based education and support
Two multidisciplinary team-building workshops to identify local barriers and enablers to implement the FeSS nurse-initiated treatment protocols.
Two site-based educational outreach meetings consisting of a standardised education programme about the FeSS treatment protocols delivered by the project officer (SD); Microsoft Powerpoint slides were left with the ASU nurse educator to be delivered to those who did not attend the meetings.
Engagement of local stroke unit coordinators through support and feedback. The Project Officer (SD) visited each intervention ASU every 6 weeks, sent three monthly proactive emails to each site, and also instigated scheduled telephone follow-up every 3 months; all acted as reminders. She also responded to any site-based request for support if needed. Newsletters were sent out yearly.

by internalmedicine | 2011-10-12 14:06 | 医学  

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