A nursing care plan implemented to treat fever, hyperglycemia, and dysphagia in patients on 19 acute stroke care units in New South Wales, Australia, in the first 72 hours after admission reduced deaths and disability compared with standard stroke care. An earlier study by the same research group showed the benefits after 90 days, and this follow-up analysis confirmed the positive outcomes four years later.
For fever, the intervention included temperature monitoring every four hours and administration of paracetamol to lower temperature when needed. Hyperglycemia management included blood glucose monitoring and saline or insulin infusion if indicated. For dysphagia detection, nurses underwent a training program by speech pathologists and later assessments to test competency in screening for swallowing problems.
“This was one of the few randomized controlled trials to demonstrate that evidence-based nursing care can have an impact on the hard end points of death and dependency,” the lead investigator, Sandy Middleton, director of the Nursing Research Institute of St. Vincent's Health Australia Sydney and the Australian Catholic University in New South Wales, told AJN.
The authors of the Quality in Acute Stroke Care study, which included 1,076 patients, hypothesized that implementing the protocols in a “rigorous” way in an organized stroke services setting and within 48 hours helped preserve key tissue. The “data clearly demonstrate the divergence in survival curves in the immediate post-trial period, which was maintained throughout the follow-up period,” the researchers wrote.
“There is now an imperative to implement these protocols internationally,” Middleton said. “Australia has included a specific new recommendation for the management of fever, hyperglycemia, and swallowing in the draft 2017 national acute stroke guidelines. These protocols are also being systematically introduced across Europe.”
Implementation of the protocol could also be helpful in the United States, she added, noting that she has heard from a U.S. colleague that fever, hyperglycemia, and swallowing may be poorly managed and monitored on some U.S. stroke units.—Serena Stockwell
Middleton S, et al Stroke 2017 48 5 1331–6