Monday, 30 July 2012: 2:15 PM
Sandy Middleton, PhD1
Peta Drury, MN2
Patrick McElduff, PhD3
Jeanette Ward, PhD4
Jeremy Grimshaw, PhD5
Simeon Dale, BA (Hons)2
Cate d'Este, PhD6
Rhonda Griffiths, PhD7
N. Wah Cheung, PhD8
Jennifer Hardy, PhD9
Elizabeth McInnes, PhD10
Christopher Levi, PhD14
(1)Nursing Research Institute & National Centre for Clinical Outcomes Research, St Vincent's & Mater Health Sydney and School of Nursing, Australian Catholic University, Darlinghurst, Australia
(2)Nursing Research Institute, St Vincent's & Mater Health Sydney and School of Nursing (NSW & ACT) Australian Catholic University, Darlinghurst, Australia
(3)Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
(4)Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
(5)Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
(6)Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia
(7)School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, Australia
(8)Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Australia
(9)Sydney Nursing School, Sydney University, Camperdown, Australia
(10)Nursing Research Institute & National Center for Clinical Outcomes Research, St Vincent's & Mater Health Sydney and School of Nursing (NSW & ACT) Australian Catholic University, Darlinghurst, Australia
(11)THe University of Newcastle, Priority Centre for Brain & Mental Health Research, Newcastle, Australia
(12)Florey Neuroscience Institutes, National Stroke Research Institute, Melbourne, Australia
(13)Nursing, Prince of Wales Hospital, Wales, Australia
(14)Priority Centre for Brain & Mental Health Research, University of Newcastle, Newcastle, Australia
Learning Objective 1: - understand the value of incorporating proven implementation strategies when introducing new treatment protocols
Learning Objective 2: - identify successful strategies to change clinician behaviour and improve patient outcomes
Changing clinical practice remains a challenge. Production of up-to-date, evidence-based clinical guidelines without targeted implementation strategies does not ensure evidence uptake. We developed and rigorously evaluated, using a cluster randomised control design, the effect on patient outcomes and clinician behaviour of a nurse-led, multidisciplinary team building intervention to improve management of fever, hyperglycaemia and swallowing following acute stroke in NSW, Australia.
Methods: 19 Australian acute stroke units (ASUs) were randomised to the intervention (n=10) or control group (n=9). Intervention ASUs received evidence-based protocols for fever, hyperglycaemia and swallowing management with multidisciplinary team building workshops, an education program and engagement of local champions. Control ASUs received only an abridged copy of the Australian stroke guidelines. Two patient cohorts (one pre and one post-intervention) were recruited. Medical records were prospectively audited by independent blinded research assistants. Intention to treat analysis was used adjusting for baseline data and clustering.
Results: Data from 1699 patients demonstrated that those from intervention ASU’s were significantly less likely to be dead or dependent at 90-days than patients from control stroke units (p=0.002); with improved SF-36 mean physical health scores (p=0.002); reductions in mean temperature (p=0·001), mean glucose (p=0·02); and improved swallow screening (p<0·001). Patients from intervention ASUs also were significantly more likely than those from control ASUs to have had all the relevant protocol monitoring and treatment elements for fever (p<0.001), glucose (p<0.001) and swallowing (p<0.001).
Conclusion: This landmark trial demonstrates the value of doing the simple things well. It is one of the few studies to show that teamwork and good bedside nursing care can influence morbidity and mortality and improve evidence uptake. This highly effective implementation strategy was simple and easily reproducible in any nursing setting. Rigorous evaluation in alternative nursing settings is warranted.