Screen-Clean-Hydrate combines and translates stroke guidelines for swallow screening within 4-hours, oral health, and hydration. The bundle incorporates specific targets, actions, and strategies to enhance acute stroke care in practice and mitigate hospital-acquired complications.
Implementation was piloted in two metropolitan stroke units and one regional hospital in South Australia. The iPARIHS knowledge translation framework guided implementation and evaluation. Clinical effectiveness was assessed by comparing rates of hospital-acquired complications in 60 patients pre- and post-implementation. Implementation strategies were collaboratively designed and prioritised with the interprofessional teams. Implementation process measures included acceptability, feasibility, uptake, and identification of barriers and enablers.
Improvements in care processes occurred where teams put their focus. Stroke Unit 1 (SU1) did not prioritise swallow screening implementation and saw no improvement (57% vs. 47%). Stroke Unit 2 (SU2), with a history of prioritizing swallow screening, maintained high compliance (83%). Both units exhibited significant improvement in individualised oral care planning (13% vs 40% and 3% vs 77%, respectively) and oral care delivery (27% vs 80% and 27% vs 70%, respectively). Hydration assessment improved substantially in both units (0% vs 40% and 7% vs 60%, respectively), with hydration planning improving in SU2 (23% vs 57%). Improvements in care practices did not appear to directly improve patient outcomes.
Screen-Clean-Hydrate improved care processes where existing clinical guidelines alone have to date not been sufficient. Sharing successful implementation strategies (including education, training, audit/feedback cycles, and visual reminders) and how barriers were addressed will assist other stroke units to improve fundamental acute stroke care.