Quality in Acute Stroke Care (QASC) Germany: improving efficiency in stroke care with nurse-initiated FeSS-protocols

Anne-Kathrin Cassier-Woidasky; Sandy Middleton; Simeon Dale; Kelly Coughlan; Catherine D'Este; Elizabeth McInnes; Dominique A Cadilhac; Waltraud Pfeilschifter

doi:10.1186/s42466-024-00352-1

Quality in Acute Stroke Care (QASC) Germany: improving efficiency in stroke care with nurse-initiated FeSS-protocols

Neurol Res Pract. 2024 Oct 17;6(1):48. doi: 10.1186/s42466-024-00352-1.

Authors

Anne-Kathrin Cassier-Woidasky¹, Sandy Middleton^{2

3}, Simeon Dale^{2

3}, Kelly Coughlan^{2

3}, Catherine D'Este^{4

5}, Elizabeth McInnes^{2

3}, Dominique A Cadilhac^{6

7}, Waltraud Pfeilschifter⁸

Affiliations

¹ Saarland University of Applied Sciences, htw saar, Goebenstraße 40, Saarbrücken, D-66117, Germany. a.cassier-woidasky@htwsaar.de.
² Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia.
³ School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia.
⁴ The Sax Institute, Sydney, Australia.
⁵ School of Medicine and Public Health, University of Newcastle, Sydney, Australia.
⁶ Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Melbourne, Australia.
⁷ Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
⁸ Department of Neurology and Clinical Neurophysiology, Klinikum Lueneburg, Lueneburg, Germany.

Abstract

Background: Nurse-initiated supported implementation of protocols to manage fever, hyperglycaemia (sugar) and swallowing (FeSS) following acute stroke reduced 90-day death and disability in the landmark Australian Quality in Acute Stroke Care (QASC)-Trial. An international interprofessional collaboration sought to evaluate the effects of nurse-led FeSS implementation on FeSS Protocol adherence in German stroke units.

Methods: This pre-test/post-test study was conducted in eight German stroke units between 2020 and 2022. Stroke nurses as clinical champions, supported by the project team, 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 from Australia. Medical record audit data were collected by nurses, pre-implementation and three months post-implementation.

Results: In 771 (pre-implementation) and 679 (post-implementation) patients there were improvements in overall FeSS adherence (pre 20%, post 28%; adjusted difference in proportions (95% CI) 11%, (5.1%, 16%); p < 0.001), adherence to hyperglycaemia (pre 43%, post 55%; adjusted difference 23%, (17%, 29%); p < 0.001) and swallowing (pre 52%, post 61%; adjusted difference 11%, (5.2%, 17%); p < 0.001) but not fever protocol (pre 76%, post 78%; adjusted difference 1.5%, (-2.6%, 5.7%); p = 0.474). Improvements also were noted in administration of anti-pyretics (pre 29%, post 59%; adjusted difference 32%, (20%, 44%); p < 0.001); and insulin (pre 41%, post 60%; adjusted difference 14%, (1.1%, 28%); p < 0.034) both within one hour, as well as in performing a swallow screen within 24 h of admission (pre 65%, post 74%; adjusted difference 18% (8.8%, 26%); p < 0.001).

Conclusions: Supported implementation of the FeSS Protocols significantly improved acute care for post stroke complications of fever, hyperglycaemia and dysphagia in terms of higher adherence and shorter time to treatment.

Trial registration: As this is a pre-test/post-test study and does not meet the WHO/ICMJE definition of a clinical trial, registration was not required.

Keywords: Dysphagia; FeSS protocol; Fever; Hypergycaemia; Nurse-led intervention; Nurses; Stroke unit.