Evidence

FeSS Protocols

In 2023 every 11 minutes someone in Australia suffered a stroke. An estimated 34,793 Australians experienced a stroke for the first in their lives in 2023 with 440, 481 survivors living across the country.¹

Three expert panels developed the FeSS Protocols in alignment with National Stroke and Diabetes clinical practice guidelines. High quality research has demonstrated that use of the FeSS Protocols directly benefits patients with:

• a 16% reduction in death and dependency at 90 days post stroke,²
• longer-term reduction in mortality out to four years,³ and
• significant cost savings to the healthcare system ($281M saving over 12 months if received by 65% of eligible patients).⁴

The FeSS Protocols have three components:

Fever Protocol

The Fever Protocol consists of monitoring the patients’ temperature at least four times a day and the prompt treatment of a temperature 37.5°C or greater in the first 72 hours, following stroke unit admission.

Elevated body temperature post stroke is common (>30%).⁵ Fever is consistently associated with worse outcomes that include marked increase in morbidity and mortality and length of hospital stay.^6-11

Hyperglycaemic (Sugar) Protocol

The Sugar Protocol consists of monitoring the patient's blood glucose levels at least four times a day for the first 48 hours following stroke unit admission (continue for 72 hours if blood glucose levels unstable), and the prompt treatment of a blood glucose level greater than 10mmols/L (180 mg/dl) in the first 48 hours following stroke unit admission.

Hyperglycaemia is common after both ischaemic and haemorrhagic stroke- affecting between 40% - 60% of patients.^12-13 Monitoring blood glucose levels is important for both diabetic and non-diabetic patients. Non-diabetic stroke patients with BGL>8mmol/L are three times more likely to die than non-diabetic patients without hyperglycaemia.¹⁴ Elevated blood glucose levels within the first 48 hours from stroke onset, are a predictor of poor outcomes (death and disability).^{12, 15-17}

Swallow Protocol

The Swallow Protocol consists of keeping patients nil by mouth (including no oral medications) until they have been screened for dysphagia by a nurse that has demonstrated competency using an approved dysphagia screening tool or assessed by a speech pathologist/ speech and language therapist. The QASC trial used the ASSIST screening tool which is also available for download but you can use your hospital-approved screening tool.

Dysphagia post stroke is common affecting about 42% of patients.¹⁸ Early dysphagia screening reduces the risk of pneumonia, mortality, overall dependency and length of stay in hospital.^19-20

Implementation strategy

• Audit and feedback
• Multidisciplinary Workshops
  • Presentation of baseline audit results
  • To present details of FeSS
  • Identification of barriers and enablers to FeSS Protocol use
  • Development of local Action Plan
  • To identify local site clinical champion
  • To develop action plan
• Didactic and interactive education
• Clinical site champions
• Reminders