Dello Simon, Lemmens Robin, Demeestere Jelle, Michiels Dominik, Wellens Lore, Weltens Caroline, Vanhaecht Kris, Bruyneel Luk
Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium.
Department of Neurosciences, University Hospitals Leuven, Belgium.
Int J Nurs Stud Adv. 2021 Feb 10;3:100023. doi: 10.1016/j.ijnsa.2021.100023. eCollection 2021 Nov.
Management of temperature, glycaemia and dysphagia, reffered to as the Fever, Sugar, Swallowing (FeSS) protocol, improves outcome in patients with acute stroke. Electronic health records can assist in efficient alignment of such clinical treatment protocol with daily patient care.
To assess the association between the implementation of the FeSS protocol, facilitated by an advanced electronic health record (EHR), and protocol adherence and outcome 90 days after hospital admission.
A single centre pre- and post-intervention study amongst patients presenting in the stroke unit within 48 h of onset of symptoms.
The stroke unit of the comprehensive stroke centre at the University Hospitals Leuven, where a standardized care programme for stroke patients is in place.
495 patients consecutively admitted in 2018 and 2019 with a diagnosis of ischaemic stroke or intracerebral haemorrhage admitted to the stroke unit, with following criteria: (1) ≥18 years of age on admission, (2) presented within 48 h of onset of symptoms to the stroke unit.
Advanced EHRs including electronic care planning and documentation offered nurses access to and support from FeSS guidelines at the point of care. We studied: (1) adherence to the protocol by nurses, (2) patient outcome as assessed by the modified Rankin Scale.
The rate of 90-day death and dependency (modified Rankin Scale ≥2) was lower in the post-intervention group (51.21%) compared to the pre-intervention group (60.34%) (adjusted OR 0.63, 95%CI 0.41-0.97). FeSS elements were more frequently documented in the post-intervention group, particularly temperature monitoring and glycaemia management. However, adherence remained suboptimal, and care plans within the electronic health record were frequently altered by nurses.
A multicomponent implementation strategy comprising of traditional implementation strategies and appended by the use of electronic health records facilitated implementation and detailed evaluation of a complex intervention. This implementation was associated with reduced death and dependency. However, a better understanding of the interaction between nurses and the EHR as a means to facilitate their work is of critical importance.
体温、血糖和吞咽管理,即发热、血糖、吞咽(FeSS)方案,可改善急性中风患者的预后。电子健康记录有助于使此类临床治疗方案与日常患者护理有效结合。
评估在先进电子健康记录(EHR)辅助下实施FeSS方案与入院90天后的方案依从性及预后之间的关联。
对症状发作48小时内入住卒中单元的患者进行单中心干预前后研究。
鲁汶大学医院综合卒中中心的卒中单元,该中心有针对卒中患者的标准化护理方案。
2018年和2019年连续收治的495例诊断为缺血性中风或脑出血并入住卒中单元的患者,符合以下标准:(1)入院时年龄≥18岁,(2)症状发作48小时内送至卒中单元。
先进的电子健康记录包括电子护理计划和文档,使护士在护理点能够获取FeSS指南并得到其支持。我们研究了:(1)护士对方案的依从性,(2)通过改良Rankin量表评估的患者预后。
干预后组90天死亡和依赖率(改良Rankin量表≥2)低于干预前组(51.21%对60.34%)(调整后的比值比为0.63,95%置信区间为0.41 - 0.97)。FeSS要素在干预后组记录得更频繁,尤其是体温监测和血糖管理。然而,依从性仍未达到最佳,电子健康记录中的护理计划经常被护士更改。
由传统实施策略组成并辅以电子健康记录使用的多成分实施策略促进了复杂干预的实施和详细评估。这种实施与死亡和依赖的减少相关。然而,更好地理解护士与电子健康记录之间的相互作用作为促进其工作的一种手段至关重要。