2.50
Hdl Handle:
http://hdl.handle.net/10755/243215
Category:
Abstract
Type:
Presentation
Title:
Doing the Simple Things Well: Good Nursing Care Reduces Death and Dependency
Author(s):
Middleton, Sandy; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique; Drury, Peta; McElduff, Patrick; Ward, Jeanette; Grimshaw, Jeremy; Dale, Simeon; d'Este, Cate; Griffiths, Rhonda; Cheung, N. Wah; Hardy, Jennifer; McInnes, Elizabeth; Levi, Christopher
Author Details:
Middleton, Sandy, PhD, sandy.middleton@acu.edu.au; Quinn, ClareEvans, MalcolmCadilhac, DominiqueDrury, Peta, MN; McElduff, Patrick, PhD; Ward, Jeanette, PhD; Grimshaw, Jeremy, PhD; Dale, Simeon, BA (Hons); d'Este, Cate, PhD; Griffiths, Rhonda, PhD; Cheung, N. Wah, PhD; Hardy, Jennifer, PhD; McInnes, ElizabethLevi, Christopher, PhD;
Abstract:
Purpose: Changing clinical practice remains a challenge.  Production of up-to-date, evidence-based clinical guidelines without targeted implementation strategies does not ensure evidence uptake.  We developed and rigorously evaluated, using a cluster randomised control design, the effect on patient outcomes and clinician behaviour of a nurse-led, multidisciplinary team building intervention to improve management of fever, hyperglycaemia and swallowing following acute stroke in NSW, Australia.

Methods: 19 Australian acute stroke units (ASUs) were randomised to the intervention (n=10) or control group (n=9). Intervention ASUs received evidence-based protocols for fever, hyperglycaemia and swallowing management with multidisciplinary team building workshops, an education program and engagement of local champions. Control ASUs received only an abridged copy of the Australian stroke guidelines. Two patient cohorts (one pre and one post-intervention) were recruited. Medical records were prospectively audited by independent blinded research assistants.  Intention to treat analysis was used adjusting for baseline data and clustering.

Results: Data from 1699 patients demonstrated that those from intervention ASU’s were significantly less likely to be dead or dependent at 90-days than patients from control stroke units (p=0.002); with improved SF-36 mean physical health scores (p=0.002); reductions in mean temperature (p=0·001), mean glucose (p=0·02); and improved swallow screening (p<0·001).  Patients from intervention ASUs also were significantly more likely than those from control ASUs to have had all the relevant protocol monitoring and treatment elements for fever (p<0.001), glucose (p<0.001) and swallowing (p<0.001).

Conclusion: This landmark trial demonstrates the value of doing the simple things well.  It is one of the few studies to show that teamwork and good bedside nursing care can influence morbidity and mortality and improve evidence uptake.  This highly effective implementation strategy was simple and easily reproducible in any nursing setting.  Rigorous evaluation in alternative nursing settings is warranted.

Keywords:
multidisciplinary; Clinician behaviour change; patient outcomes
Repository Posting Date:
12-Sep-2012
Date of Publication:
12-Sep-2012
Conference Date:
2012
Conference Name:
23rd International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Brisbane, Australia

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleDoing the Simple Things Well: Good Nursing Care Reduces Death and Dependencyen_GB
dc.contributor.authorMiddleton, Sandyen_GB
dc.contributor.authorQuinn, Clareen_GB
dc.contributor.authorEvans, Malcolmen_GB
dc.contributor.authorCadilhac, Dominiqueen_GB
dc.contributor.authorDrury, Petaen_GB
dc.contributor.authorMcElduff, Patricken_GB
dc.contributor.authorWard, Jeanetteen_GB
dc.contributor.authorGrimshaw, Jeremyen_GB
dc.contributor.authorDale, Simeonen_GB
dc.contributor.authord'Este, Cateen_GB
dc.contributor.authorGriffiths, Rhondaen_GB
dc.contributor.authorCheung, N. Wahen_GB
dc.contributor.authorHardy, Jenniferen_GB
dc.contributor.authorMcInnes, Elizabethen_GB
dc.contributor.authorLevi, Christopheren_GB
dc.author.detailsMiddleton, Sandy, PhD, sandy.middleton@acu.edu.au; Quinn, ClareEvans, MalcolmCadilhac, DominiqueDrury, Peta, MN; McElduff, Patrick, PhD; Ward, Jeanette, PhD; Grimshaw, Jeremy, PhD; Dale, Simeon, BA (Hons); d'Este, Cate, PhD; Griffiths, Rhonda, PhD; Cheung, N. Wah, PhD; Hardy, Jennifer, PhD; McInnes, ElizabethLevi, Christopher, PhD;en_GB
dc.identifier.urihttp://hdl.handle.net/10755/243215-
dc.description.abstract<b>Purpose: </b>Changing clinical practice remains a challenge.&nbsp; Production of up-to-date, evidence-based clinical guidelines without targeted implementation strategies does not ensure evidence uptake.&nbsp; We developed and rigorously evaluated, using a cluster randomised control design, the effect on patient outcomes and clinician behaviour of a nurse-led, multidisciplinary team building intervention to improve management of fever, hyperglycaemia and swallowing following acute stroke in NSW, Australia. <p><b>Methods: </b>19 Australian acute stroke units (ASUs) were randomised to the intervention (n=10) or control group (n=9). Intervention ASUs received evidence-based protocols for fever, hyperglycaemia and swallowing management with multidisciplinary team building workshops, an education program and engagement of local champions. Control ASUs received only an abridged copy of the Australian stroke guidelines. Two patient cohorts (one pre and one post-intervention) were recruited. Medical records were prospectively audited by independent blinded research assistants. &nbsp;Intention to treat analysis was used adjusting for baseline data and clustering. <p><b>Results: </b>Data from 1699 patients demonstrated that those from intervention ASU&rsquo;s were significantly less likely to be dead or dependent at 90-days than patients from control stroke units (p=0.002); with improved SF-36 mean physical health scores (p=0.002); reductions in mean temperature (p=0&middot;001), mean glucose (p=0&middot;02); and improved swallow screening (p&lt;0&middot;001). &nbsp;Patients from intervention ASUs also were significantly more likely than those from control ASUs to have had all the relevant protocol monitoring and treatment elements for fever (p&lt;0.001), glucose (p&lt;0.001) and swallowing (p&lt;0.001). <p><b>Conclusion: </b>This landmark trial demonstrates the value of doing the simple things well.&nbsp; It is one of the few studies to show that teamwork and good bedside nursing care can influence morbidity and mortality and improve evidence uptake.&nbsp; This highly effective implementation strategy was simple and easily reproducible in any nursing setting.&nbsp; Rigorous evaluation in alternative nursing settings is warranted.en_GB
dc.subjectmultidisciplinaryen_GB
dc.subjectClinician behaviour changeen_GB
dc.subjectpatient outcomesen_GB
dc.date.available2012-09-12T09:19:08Z-
dc.date.issued2012-09-12-
dc.date.accessioned2012-09-12T09:19:08Z-
dc.conference.date2012en_GB
dc.conference.name23rd International Nursing Research Congressen_GB
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen_GB
dc.conference.locationBrisbane, Australiaen_GB
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