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Background and purpose: The Registry of Stroke Care Quality (RES‐Q) is a worldwide quality improvement data platform that captures performance and quality measures, enabling standardized comparisons of hospital care. The aim of this study was to determine if, and how, RES‐Q data are used to influence stroke quality improvement and identify the support and educational needs of clinicians using RES‐Q data to improve stroke care. Methods: A cross‐sectional self‐administered online survey was administered (October 2021–February 2022). Participants were RES‐Q hospital local coordinators responsible for stroke data collection. Descriptive statistics are presented. Results: Surveys were sent to 1463 hospitals in 74 countries; responses were received from 358 hospitals in 55 countries (response rate 25%). RES‐Q data were used "always" or "often" to: develop quality improvement initiatives (n = 213, 60%); track stroke care quality over time (n = 207, 58%); improve local practice (n = 191, 53%); and benchmark against evidence‐based policies, procedures and/or guidelines to identify practice gaps (n = 179, 50%). Formal training in the use of RES‐Q tools and data were the most frequent support needs identified by respondents (n = 165, 46%). Over half "strongly agreed" or "agreed" that to support clinical practice change, education is needed on: (i) using data to identify evidence–practice gaps (n = 259, 72%) and change clinical practice (n = 263, 74%), and (ii) quality improvement science and methods (n = 255, 71%). Conclusion: RES‐Q data are used for monitoring stroke care performance. However, to facilitate their optimal use, effective quality improvement methods are needed. Educating staff in quality improvement science may develop competency and improve use of data in practice. [ABSTRACT FROM AUTHOR]

Background: The role of stroke nurses in patient selection and administration of recombinant tissue plasminogen activator (rt‐PA) for acute ischaemic stroke is evolving. Objectives: To compare differences in stroke nurses' practices related to rt‐PA administration in Australia and the United Kingdom (UK) and to examine whether these differences influence rt‐PA treatment rates. Methods: A cross‐sectional, self‐administered questionnaire administered to a lead stroke clinician from hospitals known to provide rt‐PA for acute ischaemic stroke. Chi‐square tests were used to analyse between‐country differences in ten pre‐specified rt‐PA practices. Non‐parametric equality of medians test was used to assess within‐country differences for likelihood of undertaking practices and association with rt‐PA treatment rates. Reporting followed STROBE checklist. Results: Response rate 68%; (Australia: 74% [n = 63/85]; UK: 65% [n = 93/144]). There were significant differences between countries for 7/10 practices. UK nurses were more likely to: request CT scan; screen patient for rt‐PA suitability; gain informed consent; use telemedicine to assess, diagnose or treat; assist in the decision for rt‐PA with Emergency Department physician or neurologist; and undergo training in rt‐PA administration. Reported median hospital rt‐PA treatment rates were 12% in the UK and 7.8% in Australia: (7.8%). In Australia, there was an association between higher treatment rates and nurses involvement in 5/10 practices; read and interpret CT scans; screen patient for rt‐PA suitability; gain informed consent; assess suitability for rt‐PA with neurologist/stroke physician; undergo training in rt‐PA administration. There was no relationship between UK treatment rates and likelihood of a stroke nurse to undertake any of the ten rt‐PA practices. Conclusion: Stroke nurses' active role in rt‐PA administration can improve rt‐PA treatment rates. Models of care that broaden stroke nurses' scope of practice to maximise rt‐PA treatment rates for ischaemic stroke patients are needed. Relevance to clinical practice: This study demonstrates that UK and Australian nurses play an important role in thrombolysis practices; however, they are underused. Formalising and extending the role of stroke nurses in rt‐PA administration could potentially increase thrombolysis rates with clinical benefits for patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To compare the effectiveness and safety of ultrasound‐guided fascia iliaca block (FIB) insertion in patients with fractured neck of femur by trained emergency nurses with insertion by doctors. Background: The FIB is an effective and safe form of analgesia for patients with hip fracture presenting to the emergency department (ED). While it has traditionally been inserted by medical doctors, no evidence exists comparing the effectiveness and safety of FIB insertion by nurses compared with doctors. Design: A prospective cohort study. Methods: The study was conducted in an Australian metropolitan ED. Patients admitted to the ED with suspected or confirmed fractured neck of femur had a FIB inserted under ultrasound guidance by either a trained emergency nurse or doctor. A retrospective medical record audit was undertaken of consecutive ED patients presenting between January 2013–December 2017. Reporting of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cohort studies. Results: Of the 472 patients eligible for a FIB, 322 (68%) had one inserted. A majority were inserted by doctors (n = 207, 64.3%) with 22.4% (n = 72) by nurses and in 13.3% (n = 43) of patients the clinician was not documented. There were no differences between the nurse‐inserted and doctor‐inserted groups for mean pain scores 1 hr post‐FIB insertion; clinically significant reduction (≥30%) in pain score 1 hr post‐FIB insertion; pain score 4 hr post‐FIB insertion; delirium incidence; opioid use post‐FIB insertion; or time to FIB insertion. No adverse events were identified in either group. Conclusion: Insertion of FIBs by trained emergency nurses is as effective and safe as insertion by doctors in patients with fractured neck of femur in the ED. Senior emergency nurses should routinely be inserting FIB as a form of analgesia for patients with hip fracture. Relevance to clinical practice: Our study showed trained emergency nurses can safely and effectively insert fascia iliaca blocks in patients with hip fractures. Pain was significantly reduced in a majority of patients with no reported complications. Emergency nurses should be trained to insert fascia iliaca blocks in patients with hip fractures. [ABSTRACT FROM AUTHOR]

Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources. [ABSTRACT FROM AUTHOR]

• Objective: This study aimed to evaluate the internal consistency reliability and construct validity of the Fitzpatrick Skin Type Scale during radiation therapy in a cohort of women receiving treatment for breast cancer. • Method: The assessment of the scale was performed as a nested study within a randomised controlled trial of two creams used for radiation therapy skin care for breast cancer patients. The sample consisted of 244 female patients undergoing radiation therapy for breast cancer. Participants completed a modified version of the Fitzpatrick Skin Type Scale. • Results: Internal consistency as measured by Cronbach’s alpha was 0.505, 0.829 and 0.339 for the Genetic Disposition, Sun Exposure and Tanning Habits subscales respectively. Only the Sun Exposure subscale surpassed the 0.70 cut-off, indicating good internal consistency. Maximum likelihood factor analysis with promax rotation method confirmed the a priori factor structure for the Sun Exposure subscale as well as providing evidence of construct validity for this subscale. Analysis for the other two subscales highlighted issues with internal reliability and construct validity suggesting that not all items on each subscale truly measure the intended trait. • Conclusion: The study findings support reliability and validity of the Sun Exposure subscale of the Fitzpatrick Skin Type Scale in a convenience sample of women receiving radiation therapy for cancer. Despite limitations with two of the three subscales, this tool continues to be used in clinical practice. [ABSTRACT FROM AUTHOR]