Oral Presentation Asia Pacific Stroke Conference 2024

Bridging borders for the use of evidence-based protocols for Fever, Hyperglycaemia (Sugar) and Swallow (FeSS) and clinical practice: Findings from a qualitative study of factors influencing their sustained use (107537)

Kelly Coughlan 1 2 , Oyebola Fasugba 1 2 , Simeon Dale 1 2 , Kelvin Hill 3 , Dominique Cadilhac 4 , Sandy Middleton 1 2 , Elizabeth McInnes 1 2 , Ben McElduff 1 2
  1. Nursing Research Institute , St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Sydney,Melbourne, VIC,NSW, Australia
  2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
  3. Stroke Foundation, Melbourne, VIC, Australia
  4. Stroke and Ageing Research, School of Clinical Sciences , Monash Health, Monash University, Melbourne, VIC, Australia

Background/Aims:

Two in five patients with stroke receive care according to protocols to manage fever, glucose, and swallowing (FeSS) complications. This study aimed to examine clinicians’ perspectives of factors that influence uptake and sustained adherence to FeSS Protocols.

Methods:

Semi-structured interviews and analysis were undertaken and guided by two determinant frameworks. Fourteen Stroke Coordinators (or equivalent) participated from hospitals stratified according to FeSS Protocol adherence ranking (high and low quantiles) in National Acute Stroke Services Audit cycles (2015-2021). Purposeful sample selection was informed by previous participation in a FeSS intervention study and rural/metropolitan location. Thematic analysis was undertaken, and findings compared between hospital rankings. 

Results:

Participants from hospitals with consistently high adherence were from well-established stroke units. Protected bed space; staffing; protocols embedded in hospital specific processes, were reported as enablers as were strong professional networks and use of routinely collected data. One hospital with low adherence had a stroke unit but reported low engagement from hospital executives and an unstable workforce as barriers. Working relationships between departments and disciplines were a barrier (low adherence hospitals) and an enabler (high adherence hospitals). Belief in the evidence and perceived patient risk also influenced uptake and adherence.

 

Conclusion:

This study has contributed to the literature on clinical practice change sustainability by identifying organisational and individual barriers and enablers from hospitals according to high and low FeSS Protocol adherence. Understanding these influences can direct future efforts towards implementation, to optimise stroke care and improve patient outcomes.