The Fever, Sugar and Swallowing (FeSS) intervention was developed as part of the QASC trial. Learn more about the intervention, and download further resources.


Changing clinician practice remains a challenge. Production of up-to-date evidence-based clinical guidelines without targeted implementation strategies does not ensure evidence uptake. There is evidence of failure to translate research findings into clinical practice: 30-40% of patients do not get treatments of proven effectiveness; 20-25% of patients receive care that is not needed or potentially harmful (Schuster et al. 1998); with only 55% of patients receiving recommended care (McGlynn et al. 2003). 

A 2010 Cochrane review concluded that, “Interventions tailored to prospectively identified barriers are more likely to improve professional practice than no intervention or dissemination of guidelines” (Baker et al. 2010. p.2).

About the Fever, Sugar and Swallowing (FeSS) intervention

The QASC trial used an evidence-based implementation strategy based on behaviour change principles to foster teamwork and collaboration amongst multidisciplinary clinicians to implement clinical protocols for the management of fever, hyperglycaemia and swallowing difficulties.  

We then rigorously evaluated the effect of this intervention on patient outcomes using a cluster randomised control design. 

Learn more about the FeSS intervention below. If you’d like to access further resources, you can register your details using our online form.

Register to download FeSS intervention resources

FeSS clinical treatment protocols

Three expert panels developed the FeSS clinical treatment protocols.  The Fever and Sugar protocols were implemented for the first 72 hours following stroke unit admission.  

In brief:

  • The Fever protocol consists of monitoring the patients’ temperature and the prompt treatment of a temperature 37.5°C or greater in the first 72 hours, following stroke unit admission.
  • The Sugar protocol consists of monitoring the patient's blood glucose levels for the first 72 hours following stroke unit admission, and the prompt treatment of a blood glucose level greater than 10mmols/L in the first 48 hours following stroke unit admission.
  • The Swallow protocol consists of nurses undergoing education and assessment of competency to enable them to screen patients for swallowing difficulties (the QASC trial used the ASSIST screening tool which is also available for download). 

FeSS implementation strategy

The FeSS implementation strategy consisted of workshops, educational presentations and reminders. 

Two team-building workshops were held at each stroke unit to identify perceived barriers and enablers prior to implementation of the clinical protocols.

Two interactive and didactic educational outreach meetings were conducted to inform all stroke unit staff about the protocols.

Reminders and ongoing support for the study were given.


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