德国急性卒中护理质量（QASC）：通过护士启动的FeSS方案提高卒中护理效率。
Quality in Acute Stroke Care (QASC) Germany: improving efficiency in stroke care with nurse-initiated FeSS-protocols.
作者信息
Cassier-Woidasky Anne-Kathrin, Middleton Sandy, Dale Simeon, Coughlan Kelly, D'Este Catherine, McInnes Elizabeth, Cadilhac Dominique A, Pfeilschifter Waltraud
机构信息
Saarland University of Applied Sciences, htw saar, Goebenstraße 40, Saarbrücken, D-66117, Germany.
Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia.
出版信息
Neurol Res Pract. 2024 Oct 17;6(1):48. doi: 10.1186/s42466-024-00352-1.
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.
背景
在具有里程碑意义的澳大利亚急性卒中护理质量（QASC）试验中，由护士发起并支持实施的急性卒中后发热、高血糖（血糖）和吞咽管理方案（FeSS）降低了90天的死亡率和残疾率。一项国际跨专业合作旨在评估护士主导的FeSS方案实施对德国卒中单元中FeSS方案依从性的影响。
方法
这项前后测试研究于2020年至2022年在德国的8个卒中单元进行。卒中护士作为临床倡导者，在项目团队的支持下，开展多学科研讨会，讨论实施前病历审核结果、FeSS方案实施的障碍和促进因素，制定行动计划并提供教育，并持续获得来自澳大利亚的支持。护士在实施前和实施后三个月收集病历审核数据。
结果
在771名（实施前）和679名（实施后）患者中，FeSS总体依从性有所改善（实施前20%，实施后28%；比例调整差异（95%CI）为11%，（5.1%，16%）；p<0.001），高血糖管理的依从性（实施前43%，实施后55%；调整差异23%，（17%，29%）；p<0.001）和吞咽管理的依从性（实施前52%，实施后61%；调整差异11%，（5.2%，17%）；p<0.001）有所改善，但发热方案的依从性未改善（实施前76%，实施后78%；调整差异1.5%，（-2.6%，5.7%）；p=0.474）。在一小时内使用退烧药（实施前29%，实施后59%；调整差异32%，（20%，44%）；p<0.001）和胰岛素（实施前41%，实施后60%；调整差异14%，（1.1%，28%）；p<0.034）以及在入院后24小时内进行吞咽筛查（实施前65%，实施后74%；调整差异18%（8.8%，26%）；p<0.001）方面也有改善。
结论
支持实施FeSS方案在提高依从性和缩短治疗时间方面显著改善了卒中后发热、高血糖和吞咽困难并发症的急性护理。
试验注册
由于这是一项前后测试研究，不符合世界卫生组织/国际医学期刊编辑委员会对临床试验的定义，因此无需注册。
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