Management of Fever, Hyperglycemia, and Dysphagia in an Acute Stroke Unit.
PURPOSE
Adherence to treatment protocols to manage fever, hyperglycemia, and dysphagia is associated with reduced levels of mortality and morbidity in acute stroke patients. However, the extent of research translation in this area is unclear. The aim of this study was to determine whether there is an evidence-practice gap in the management of fever, hyperglycemia, and dysphagia in an acute stroke unit.


DESIGN
Medical records were audited to determine whether clinical practice was consistent with best practice, as defined by treatment protocols used within the Quality in Acute Stroke Care study.


METHODS
Data were collected regarding the assessment and management of fever, hyperglycemia, and dysphagia. Reasons for variance from "best practice" care were noted. The case note audit took place in an acute stroke unit in a large teaching hospital in Australia. Participants were 53 stroke survivors discharged from the study site over a 6-month period in 2013.


FINDINGS
Care processes did not consistently reflect best practice. Temperature was monitored 4-6 hourly in 62% of the patients. Fifty-three percent of the patients had a fingerprick blood glucose level on admission to the stroke unit and only 4% of the patients were monitored 6th hourly. Data showed that 83% of the patients received a swallow assessment within 24 hours by a speech pathologist. Thirty percent of the patients were given food and fluids before speech assessment. Only eight patients (26%) directly admitted to the stroke unit received best practice assessment of temperature, blood glucose, and dysphagia.


CONCLUSIONS
Current practice does not reflect best practice. Barriers to research translation are currently unclear but must be overcome to improve care quality for stroke survivors. Multifaceted interventions to ensure uptake of care protocols are required.


CLINICAL RELEVANCE
Consistent provision of evidence-based practice needs to be available to ensure patients are provided with the best nursing care following stroke.
['Kenny|Teresa|T|', 'Barr|Christopher|C|', 'Laver|Kate|K|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001315:Australia D003680:Deglutition Disorders D019468:Disease Management D005260:Female D005334:Fever D019983:Guideline Adherence D006760:Hospitalization D006801:Humans D006943:Hyperglycemia D008297:Male D008875:Middle Aged D011787:Quality of Health Care D019145:Rehabilitation Nursing D020521:Stroke D000071939:Stroke Rehabilitation
fever hyperglycemia dysphagia Stroke nursing clinical protocols evidence-based nursing