A study by the Nursing Research Institute has found three simple protocols to be more effective than the current treatment for acute stroke patients. Alisse Grafitti spoke to Professor Sandy Middleton about the landmark research.
Acute stroke patients who receive three clinical protocols to manage fever, sugar and swallowing are 16 per cent more likely to be alive and independent three months later - a collaborative research study led by Professor Middleton, Director of the Nursing Research Institute at ACU and St Vincents & Mater Health Sydney has found.
Stroke is caused by a clot or a bleed in the brain and is Australia’s second biggest cause of death and a leading cause of disability. While a patient suffers irreversible brain damage as a result of the stroke, there is potential to salvage surrounding brain tissue and limit the damage by effectively managing fever, sugar and swallowing.
The trial was funded by the National Health and Medical Research Council (NHMRC), and was the first nurse-led trial in acute stroke of its kind carried out in Australia - involving 19 acute stroke units across New South Wales and more than 1,600 patients.
The trial developed, implemented and evaluated the effectiveness of team-building workshops and education to introduce three clinical protocols to manage fever, sugar and swallowing following an acute stroke.
“We found that patients admitted to hospital with an acute stroke, who received these protocols, were 16 per cent more likely to be alive and independent at 90 days,” Professor Middleton said.
“These results are better than any current drug or treatment for stroke including clot-busting therapy, and can be universally applied in acute stroke units.”
The study showed that patients who received care in stroke units using these protocols were also more likely to have fewer episodes of fever, lower average temperatures and sugar levels, and better screening for swallowing difficulties.
“These findings demonstrate that consistent nursing care can be just as important as medical breakthroughs,” Professor Middleton said.
“This is the first study of its kind internationally, made all the more significant in that this effect was not due to a drug or a device but as a result of teamwork and good nursing care.”
“While good management of fever, high blood sugar levels and swallowing can salvage brain tissue - poor management can result in extension of the stroke and have devastating consequences for the patient.”
The study was a collaboration between ACU, the University of Newcastle, the University of Ottawa, the University of Western Sydney, the University of Sydney and the University of Melbourne, as well as a team of clinicians from NSW Health and support from the Agency for Clinical Innovation’s Stroke Services NSW.
The landmark research took out top honours at the 2011 Canadian Stroke Congress, and Professor Middleton was recently awarded an additional $2.5 million in funding from NHMRC to roll out the trial in emergency departments around Australia.
The National Stroke Foundation is encouraging the delivery of programs in Australian stroke units to support the use of the protocols based on the success of Professor Middleton’s trial.
“Recovery after a stroke can be significantly improved when health professionals are supported to implement protocols that ensure consistent and prompt clinical management of these three factors,” said CEO Dr Erin Lalor. “The delivery of programs resulting in improved care for stroke care is critical in ensuring more Australians survive stroke, and that costs associated with stroke care are minimised.”
Professor Middleton said she was delighted to find so many stroke units eager to step up and adopt the new procedures.
10 things you should know about stroke
1. Stroke is Australia’s second single greatest killer after coronary heart disease and a leading cause of disability.
2. In 2011, Australians will suffer around 60,000 new and recurrent strokes – that’s one stroke every 10 minutes.
3. One in five people having a first-ever stroke die within one month and one in three die within a year.
4. The number of strokes will increase each year due to the ageing population unless something is done to reduce the incidence rate.
5. The FAST test is an easy way to recognise and remember the signs of stroke. Using the FAST test involves asking three simple questions:
• Face – Check their face. Has their mouth drooped?
• Arms – Can they lift both arms?
• Speech – Is their speech slurred? Do they understand you?
• Time – Time is critical. If you see any of these signs call 000 now!
6. In the next 10 years more than half a million people will suffer a stroke.
7. Stroke kills more women than breast cancer and more men than prostate cancer.
8. About 88 per cent of stroke survivors live at home and most have a disability.
9. Close to 20 per cent of all strokes occur to people under 55 years old.
10. Strokes cost Australia an estimated $2.14 billion a year.
Source: The National Stroke Foundation.