Conectar
To: (i) examine Stroke Coordinators' perspectives of factors influencing sustained adherence to evidence-based protocols to manage Fever, Sugar (hyperglycaemia) and Swallow (FeSS) and (ii) compare findings between hospitals with consistently high FeSS Protocol adherence versus those with consistently low or variable adherence.
Qualitative descriptive process evaluation using in-depth, individual semi-structured interviews.
Hospitals that participated in ≥ 3 national stroke audit cycles were ranked by mean adherence to FeSS Protocols and stratified by consistently high, low and variable adherence. Three hospitals from each adherence strata were purposefully selected after further stratification by (i) previous participation in a FeSS Intervention study; and (ii) location (state, remoteness). Inductive thematic analysis was undertaken, with themes mapped to factors from the framework to compare findings by adherence level and contextualise the findings in relation to sustainability.
Analysis of 14 interviews identified two themes [and sub-themes]: (1) Stroke Coordinator as sustainability champions and boundary spanners [maintenance of implementation strategies; fostering working relationships, communication and influence] mapped to Workforce factors, organisational and Innovation-specific factors; and (2) Hospital executive and middle management respect of stroke specialty [designated area for stroke care; recognition of stroke specialist nursing skills; previous FeSS Intervention study participation] mapped to Workforce and Political factors. Key differences by adherence groupings related to the Stroke Coordinator model, workplace configuration, and the impact of interdepartmental relationships and competing organisational directives.
The Stroke Coordinator role was pivotal for sustained use of evidence-based FeSS Protocols for acute stroke care, driving multidisciplinary collaboration.
Internationally, many patients do not receive evidence-based acute stroke care. Despite the proven benefits of the FeSS Protocols, consistent implementation remains a challenge. This study recognises the critical importance of a dedicated Stroke Coordinator for all acute stroke hospitals. Their advocacy for the use of evidence-based interventions is key to improving stroke outcomes.
This study did not include patient or public involvement in its design, conduct, or reporting as it focused solely on the professional experiences of stroke care providers.
ACTRN 12623000445673. Registered 1 May 2023
To investigate the effects of organisational interventions on the incidence, healing and management of pressure injuries in adult patients in acute hospital settings.
Systematic review.
The review included adult patients at risk of or with pre-existing pressure injuries in acute hospital settings, excluding mental health units, emergency departments or operating theatres. Interventions employed in the included studies were categorised using the Cochrane Effective Practice and Organisation of Care taxonomy.
Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Complete and Web of Science Core Collection were searched from 01 January 2012 to 31 December 2023.
Of 8861 records identified, 7 prevention studies met the inclusion criteria. Six studies reported reductions in pressure injury incidence. Included studies employed various combinations of 14 organisational strategies to enhance practices. Educational interventions were utilised in six studies, including educational meetings, materials and outreach visits. Other common strategies included audit and feedback, communities of practice and continuous quality improvement. The interventions targeted patients and clinicians, primarily nurses, with some involving multidisciplinary teams. The focus was on enhancing healthcare practices through systematic approaches and stakeholder engagement.
Organisational strategies targeting both patients and clinicians as part of an intervention bundle may enhance the prevention of pressure injuries in acute hospital settings. Further, high-quality effectiveness–implementation hybrid trials are required to evaluate these strategies.
Organisational factors influence clinicians' ability to implement evidence-based practices. The effectiveness of specific organisational strategies in acute settings is uncertain. Multiple organisational strategies targeting patients and clinicians may improve the implementability of a pressure injury prevention intervention.
This study adhered to PRISMA guidelines.
Neither patients nor the public were directly involved in this study.
FreshRSS 