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Back to Basics: Adherence With Guidelines for Glucose and Temperature Control in an American Comprehensive Stroke Center Sample

Alexandrov, Anne, W.; Palazzo, Paola; Biby, Sharon; Doerr, Abbigayle; Dusenbury, Wendy; Young, Rhonda; Lindstrom, Anne; Grove, Mary; Tsivgoulis, Georgios; Middleton, Sandy; Alexandrov, Andrei, V.

Journal of Neuroscience Nursing: June 2018 - Volume 50 - Issue 3 - p 131–137
doi: 10.1097/JNN.0000000000000358
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ABSTRACT Background: Variance from guideline-directed care for glucose and temperature control remains unknown in the United States at a time when priorities have shifted to ensure rapid diagnosis and treatment of acute stroke patients. However, protocol-driven nursing surveillance for control of hyperglycemia and hyperthermia has been shown to improve patient outcomes. Methods: We conducted an observational pilot study to assess compliance with American guidelines for glucose and temperature control and association with discharge outcomes in consecutive acute stroke patients admitted to 5 US comprehensive stroke centers. Data for the first 5 days of stroke admission were collected from electronic medical records and entered and analyzed in SPSS using descriptive statistics, Mann-Whitney U test, Student t tests, and logistic regression. Results: A total of 1669 consecutive glucose and 3782 consecutive temperature measurements were taken from a sample of 235 acute stroke patients; the sample was 87% ischemic and 13% intracerebral hemorrhage. Poor glucose control was found in 33% of patients, and the most frequent control method ordered (35%) was regular insulin sliding scale without basal dosing. Poor temperature control was noted in 10%, and 39% did not have temperature recorded in the emergency department. Lower admission National Institutes of Health Stroke Scale score and well-controlled glucose were independent predictors of favorable outcome (discharge modified Rankin Scale score, 0–2) in reperfusion patients. Conclusion: Glucose and temperature control may be overlooked in this era of rapid stroke diagnosis and treatment. Acute stroke nurses are well positioned to assume leadership of glucose and temperature monitoring and treatment.

Questions or comments about this article may be directed to Anne W. Alexandrov, PhD RN AGACNP-BC CCRN NVRN-BC ANVP-BC FAAN, at Anne@outcomesmgmt.org. She is Professor of Nursing and Professor of Neurology, Department of Acute and Critical Care, College of Nursing, and Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN; and NET SMART, Health Outcomes Institute, Fountain Hills, AZ.

Paola Palazzo, MD, is Stroke Neurologist, Department of Neurology, Poitiers University Hospital, Poitiers, France; and San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy.

Sharon Biby, MSN RN AGPCNP-BC ANVP-BC, NET SMART, is Stroke Team Nurse Practitioner, Health Outcomes Institute, Fountain Hills, AZ; and The Moses Cone Memorial Hospital, Cone Health, Greensboro, NC.

Abbigayle Doerr, DNP RN FNP-BC ANVP-BC, NET SMART, is Manager, Interventional Labs, Health Outcomes Institute, Fountain Hills, AZ; and Northwestern Medicine, Central DuPage Hospital, Winfield, IL.

Wendy Dusenbury, DNP RN AGACNP-BC FNP-BC ANVP-BC, is Stroke Team Nurse Practitioners, Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN; NET SMART, Health Outcomes Institute, Fountain Hills, AZ; and Assistant Professor, College of Nursing, Wichita State University, Wichita, KS.

Rhonda Young, MSN RN FNP-BC ANVP-BC, is Nurse Practitioner, The Little Clinic, Wichita, KS.

Anne Lindstrom, is Stroke Program Director, MSN RN FNP-BC, Northwestern Medicine, Central DuPage Hospital, Winfield, IL.

Mary Grove, MSN RN ACNP-BC, is PhD Candidate, Department of Acute and Critical Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN; and Institute for Evidence Based Care, Hackensack Meridian Health, Neptune, NJ.

Georgios Tsivgoulis, MD PhD, is Professor, Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN; and Second Department of Neurology, Attikon University Hospital, Chaidari, and School of Medicine, University of Athens, Athens, Greece.

Sandy Middleton, PhD RN, is Professor of Nursing, Nursing Research Institute, Australian Catholic University, and St Vincent’s Health Australia, Sydney, Australia.

Andrei V. Alexandrov, MD, is Professor and Chairman, Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN.

The authors declare no conflicts of interest.

© 2018 American Association of Neuroscience Nurses