Management of Fever, Hyperglycemia, and Dysphagia in an Acute Stroke Unit.

Abstract

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. 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. 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. 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 24hours 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. 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. Consistent provision of evidence-based practice needs to be available to ensure patients are provided with the best nursing care following stroke.