Enhancing blood pressure management protocol implementation in patients with acute intracerebral haemorrhage through a nursing-led approach : A retrospective cohort study
Pancorbo, Olalla (Universitat Autònoma de Barcelona. Departament de Medicina)
Sanjuan, Estela (Universitat Autònoma de Barcelona. Departament de Medicina)
Rodríguez Samaniego, María Teresa (Hospital Universitari Vall d'Hebron)
Miñarro, Olga (Hospital Universitari Vall d'Hebron)
Simonetti, Renato (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Olivé-Gadea, Marta (Hospital Universitari Vall d'Hebron. Institut de Recerca)
García-Tornel, Álvaro (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rodriguez-Villatoro, Noelia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Muchada, Marian (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rubiera Del Fueyo, Marta A. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Álvarez Sabín, José (Universitat Autònoma de Barcelona. Departament de Medicina)
Molina, Carlos (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rodriguez-Luna, David (Universitat Autònoma de Barcelona. Departament de Medicina)

Data:	2024
Resum:	Aim: To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients. Design: Retrospective cohort study of prospectively collected data over 6 years. Methods: Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan. We differentiated six periods: P1, stroke nurse at computed tomography suite (baseline period); P2, antihypertensive titration by stroke nurse; P3, retraining by neurologists; P4, integration of a stroke advanced practice nurse; P5, after COVID-19 impact; and P6, retraining by stroke advanced practice nurse. Outcomes included first-hour target achievement (primary outcome), tomography-to-treatment and treatment-to-target times, first-hour maximum dose of antihypertensive treatment and 6-h and 24-h systolic blood pressure variability. Results: Compared to P1, antihypertensive titration by stroke nurses (P2) reduced treatment-to-target time and increased the rate of first-hour target achievement, retraining of stroke nurses by neurologists (P3) maintained a higher rate of first-hour target achievement and the integration of a stroke advanced practice nurse (P4) reduced both 6-h and 24-h systolic blood pressure variability. However, 6-h systolic blood pressure variability increased from P4 to P5 following the impact of the COVID-19 pandemic. Finally, compared to P1, retraining of stroke nurses by stroke advanced practice nurse (P6) reduced tomography-to-treatment time and increased the first-hour maximum dose of antihypertensive treatment. Conclusion: Changes in nursing care and continuous education can significantly enhance the time metrics and blood pressure outcomes in acute intracerebral haemorrhage patients. Reporting Method: STROBE guidelines. Patient and Public Contribution: No Patient or Public Contribution.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Adult nursing ; Evidence-based practice ; Practice nursing ; Stroke
Publicat a:	Journal of clinical nursing, Vol. 33 Núm. 4 (april 2024) , p. 1398-1408, ISSN 1365-2702

DOI: 10.1111/jocn.17080

11 p, 1.6 MB

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