Evaluating remote facilitation intensity for multi-national translation of nurse-initiated stroke protocols (QASC Australasia): a protocol for a cluster randomised controlled trial.

BACKGROUND: Facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing difficulties (FeSS Protocols) in 19 Australian stroke units resulted in reduced death and dependency for stroke patients. However, a significant gap remains in translating this evidence-based care bundle protocol into standard practice in Australia and New Zealand. Facilitation is a key component for increasing implementation. However, its contribution to evidence translation initiatives requires further investigation. We aim to evaluate two levels of intensity of external remote facilitation as part of a multifaceted intervention to improve FeSS Protocol uptake and quality of care for patients with stroke in Australian and New Zealand acute care hospitals. METHODS: A three-arm cluster randomised controlled trial with a process evaluation and economic evaluation. Australian and New Zealand hospitals with a stroke unit or service will be recruited and randomised in blocks of five to one of the three study arms-high- or low-intensity external remote facilitation or a no facilitation control group-in a 2:2:1 ratio. The multicomponent implementation strategy will incorporate implementation science frameworks (Theoretical Domains Framework, Capability, Opportunity, Motivation - Behaviour Model and the Consolidated Framework for Implementation Research) and include an online education package, audit and feedback reports, local clinical champions, barrier and enabler assessments, action plans, reminders and external remote facilitation. The primary outcome is implementation effectiveness using a composite measure comprising six monitoring and treatment elements of the FeSS Protocols. Secondary outcome measures are as follows: composite outcome of adherence to each of the combined monitoring and treatment elements for (i) fever (n=5); (ii) hyperglycaemia (n=6); and (iii) swallowing protocols (n=7); adherence to the individual elements that make up each of these protocols; comparison for composite outcomes between (i) metropolitan and rural/remote hospitals; and (ii) stroke units and stroke services. A process evaluation will examine contextual factors influencing intervention uptake. An economic evaluation will describe cost differences relative to each intervention and study outcomes. DISCUSSION: We will generate new evidence on the most effective facilitation intensity to support implementation of nurse-initiated stroke protocols nationwide, reducing geographical barriers for those in rural and remote areas. TRIAL REGISTRATION: ACTRN12622000028707. Registered 14 January, 2022.

Knowledge of blood pressure in a U.K. general public population.

Little is known about the general public's understanding of the role of blood pressure (BP) in contributing to heart disease and stroke. This study aimed to gain a wider understanding of the knowledge and awareness of BP in a selected London population. As part of a stroke awareness campaign, members of the public were offered BP testing and were asked about their knowledge and awareness of BP. Descriptive statistics were employed to explore knowledge and awareness of BP. χ2-test was run to explore the difference between knowledge and awareness of BP, and whether there was a difference in BP readings in normotensive and hypertensive participants. A total of 1019 participants (males 295; mean age 54 years, range 16-92) were recruited with a mean BP of 130/77 mm Hg. Over half (52%) of the total population was unable to correctly estimate an acceptable range of BP, and of that group 28% had a systolic BP (SBP) >140 mm Hg. Of the 31% self-reporting hypertension and on medication, over a quarter (27%) did not know the range for acceptable BP. A third were poorly controlled with a SBP >140 mm Hg. Mean SBP in the hypertensive participants who correctly estimated 'acceptable BP' was 3 mm Hg lower (147 mm Hg) than those who guessed incorrectly (150 mm Hg) (P<0.04). There remains a lack of understanding of BP in the general public population with individuals having little knowledge of an acceptable BP range. Hypertensive patients demonstrate a particularly poor understanding of BP. This study suggests that good knowledge of BP influences BP control in a hypertensive population and has important public health implications.

A thrombolysis pathway for patients following acute ischaemic stroke.

Thrombolysis is a promising treatment for patients with acute ischaemic stroke. However, a major barrier to treatment is that it needs to be administered within 4.5 hours of stroke onset. Training and education is key to the timely delivery of thrombolytic therapy to patients following acute stroke. This article describes the thrombolysis care pathway in use in one hyperacute stroke unit and outlines the core competencies required of the acute stroke nurse.