ORCID Profile
0000-0002-5340-7379
Current Organisations
Australian Catholic University
,
University of Wollongong
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Publisher: Wiley
Date: 05-05-2016
DOI: 10.1111/IJN.12396
Abstract: The uptake of evidence into practice may be impeded or facilitated by in idual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence-based practice (EBP) and readiness for change. Overall Nurse Managers reported high-level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP.
Publisher: Cambridge Media
Date: 25-06-2019
Abstract: Background Surgical patients are at high risk of developing pressure injuries (Pls) due to anaesthesia-induced immobility as well as risk factors such as length of surgery and co-morbidities. Few Australian studies have investigated the incidence of PIs in surgical patients. This prospective cohort study assessed the incidence of post-surgical PIs and identified gaps in pressure injury prevention (PIP) for elective surgical patients. Methods Consecutive elective surgery patients at an urban tertiary referral hospital were recruited who had an expected length of stay of hours. Baseline PI risk (measured by the Waterlow scale) and PIP strategies implemented at five time points were collected from medical records. Two prospective outcome assessments were conducted at 24 and 48 hours post-operatively. Data were analysed descriptively. Results One patient out of 150 (incidence rate 0.7) developed an intra-operative Stage 1 PI. Four patients developed skin tears. PIP strategies were applied inconsistently throughout the patient journey, regardless of risk status. Conclusions While the incidence of surgically acquired PIs in this study was low, ongoing staff education is needed about the importance of consistent skin and risk assessments and of implementing strategies appropriate for level of PI risk.
Publisher: SAGE Publications
Date: 10-11-2013
DOI: 10.1111/IJS.12194
Abstract: Fever, hyperglycemia, and swallow dysfunction poststroke are associated with significantly worse outcomes. We report treatment and monitoring practices for these three items from a cohort of acute stroke patients prior to randomization in the Quality in Acute Stroke Care trial. Retrospective medical record audits were undertaken for prospective patients from 19 stroke units. For the first three-days following stroke, we recorded all temperature readings and administration of paracetamol for fever (≥37.5°C) and all glucose readings and administration of insulin for hyperglycemia ( mmol/L). We also recorded swallow screening and assessment during the first 24 h of admission. Data for 718 (98%) patients were available 138 (19%) had four hourly or more temperature readings and 204 patients (29%) had a fever, with 44 (22%) receiving paracetamol. A quarter of patients ( n = 102/412, 25%) had six hourly or more glucose readings and 23% (95/412) had hyperglycemia, with 31% (29/95) of these treated with insulin. The majority of patients received a swallow assessment ( n = 562, 78%) by a speech pathologist in the first instance rather than a swallow screen by a nonspeech pathologist ( n = 156, 22%). Of those who passed a screen ( n = 108 of 156, 69%), 68% ( n = 73) were reassessed by a speech pathologist and 97% ( n = 71) were reconfirmed to be able to swallow safely. Our results showed that acute stroke patients were: undermonitored and undertreated for fever and hyperglycemia and underscreened for swallowing dysfunction and unnecessarily reassessed by a speech pathologist, indicating the need for urgent behavior change.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.IJNURSTU.2018.09.014
Abstract: The Quality in Acute Stroke Care Trial implemented nurse-initiated protocols to manage fever, hyperglycaemia and swallowing (Fever, Sugar, Swallow clinical protocols) achieving a 16% absolute improvement in death and dependency 90-day post-stroke. To examine associations between 90-day death and dependency, and monitoring and treatment processes of in-hospital nursing stroke care targeted in the trial. Secondary data analysis from a single-blind cluster randomised control trial. 19 acute stroke units in New South Wales, Australia. English-speakers ≥18 years with ischaemic stroke or intracerebral haemorrhage arriving at participating stroke units <48 h of stroke onset, excluding those for palliation and without a telephone. Data from patients in the 10 intervention hospitals and the nine control hospitals in the QASC trial post-intervention cohort, who had both hospital process of care data and 90-day outcome data were included. Associations between independence at 90-day (modified Rankin Score ≤1) and processes of care for fever, hyperglycaemia, and dysphagia screening were examined using multiple logistic regression adjusting for treatment group, sex, age group, premorbid modified Rankin scale, marital status, education, stroke severity and correlation within hospitals. Of 1126 patients in the post-intervention cohort (intervention or control), 970 had both in-hospital processes of care data and 90-day outcome data. Patients had significantly lower odds of 90-day independence if, within the first 72 h of stroke unit admission, they had one or more: febrile event (≥37.5 °C) (OR 0.47 95%CI:0.35-0.61 P < 0.0001), higher mean temperature (OR:0.25 95%CI:0.14-0.45 P < 0.0001), finger-prick blood glucose reading ≥11 mmol/L (OR:0.61 95%CI:0.47-0.79 P = 0.0002), higher mean blood glucose (OR 0.89 95%CI:0.84-0.95 P = 0.0006), or failed the swallowing screen (OR 0.35 95%CI:0.22-0.56 P < 0.0001). Patients had greater odds of independence when: venous blood glucose was taken on admission to hospital or within 2 h of stroke unit admission (OR 1.4 95%CI:1.01-1.83 P = 0.04) finger-prick blood glucose was measured within 72 h of stroke unit admission (OR 1.3 95%CI:1.02-1.55 P = 0.03) or when swallowing screening or assessment was performed within 24 h of stroke unit admission (OR 1.8 95%CI:1.29-2.55 P = 0.0006). We have provided robust evidence of the importance of monitoring patients' temperature, blood glucose and swallowing status to improve 90-day stroke outcomes. Routine nursing care can result in significant reduction in death and dependency post-stroke.
Publisher: Springer Science and Business Media LLC
Date: 25-02-2012
Publisher: Elsevier BV
Date: 11-2011
Publisher: SAGE Publications
Date: 12-2013
DOI: 10.1111/IJS.12202
Abstract: Our randomized controlled trial of a multifaceted evidence-based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunction in the first three-days following stroke improved outcomes at 90 days by 15%. We designed a quantitative process evaluation to further explain and illuminate this finding. Blinded retrospective medical record audits were undertaken for patients from 19 stroke units prior to and following the implementation of three multidisciplinary evidence-based protocols (supported by team-building workshops, and site-based education and support) for the management of fever (temperature ≥37·5°C), hyperglycemia (glucose mmol/l), and swallowing dysfunction in intervention stroke units. Data from 1804 patients (718 preintervention 1086 postintervention) showed that significantly more patients admitted to hospitals allocated to the intervention group received care according to the fever ( n = 186 of 603, 31% vs. n = 74 of 483, 15%, P 0·001), hyperglycemia ( n = 22 of 603, 3·7% vs. n = 3 of 483,0·6%, P = 0·01), and swallowing dysfunction protocols ( n = 241 of 603, 40% vs. n = 19 of 483, 4·0%, P ≤ 0·001). Significantly more patients in these intervention stroke units received four-hourly temperature monitoring ( n = 222 of 603, 37% vs. n = 90 of 483, 19%, P 0·001) and six-hourly glucose monitoring (194 of 603, 32% vs. 46 of 483, 9·5%, P 0·001) within 72 hours of admission to a stroke unit, and a swallowing screen (242 of 522, 46% vs. 24 of 350, 6·8%, P ≤ 0·0001) within the first 24 hours of admission to hospital. There was no difference between the groups in the treatment of patients with fever with paracetamol (22 of 105, 21% vs. 38 of 131, 29%, P = 0·78) or their hyperglycemia with insulin (40 of 100, 40% vs. 17 of 57, 30%, P = 0·49). Our intervention resulted in better protocol adherence in intervention stroke units, which explains our main trial findings of improved patient 90-day outcomes. Although monitoring practices significantly improved, there was no difference between the groups in the treatment of fever and hyperglycemia following acute stroke. A significant link between improved treatment practices and improved outcomes would have explained further the success of our intervention, and we are still unable to explain definitively the large improvements in death and dependency found in the main trial results. One potential explanation is that improved monitoring may have led to better overall surveillance of deteriorating patients and faster initiation of treatments not measured as part of the main trial.
Location: Australia
No related grants have been discovered for Peta Drury.