Divisions of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02446, USA.
J Am Geriatr Soc. 2010 Jun;58(6):1019-26. doi: 10.1111/j.1532-5415.2010.02871.x. Epub 2010 May 7.
To determine whether a delirium abatement program (DAP) can shorten duration of delirium in new admissions to postacute care (PAC).
Cluster randomized controlled trial.
Eight skilled nursing facilities specializing in PAC within a single metropolitan region.
Four hundred fifty-seven participants with delirium at PAC admission.
The DAP consisted of four steps: assessment for delirium within 5 days of PAC admission, assessment and correction of common reversible causes of delirium, prevention of complications of delirium, and restoration of function.
Trained researchers screened eligible patients. Those with delirium defined according to the Confusion Assessment Method were eligible for participation using proxy consent. Regardless of location, researchers blind to intervention status re-assessed participants for delirium 2 weeks and 1 month after enrollment.
Nurses at DAP sites detected delirium in 41% of participants, versus 12% in usual care sites (P<.001), and completed DAP documentation in most participants in whom delirium was detected, but the DAP intervention had no effect on delirium persistence based on two measurements at 2 weeks (DAP 68% vs usual care 66%) and 1 month (DAP 60% vs usual care 51%) (adjusted P> or =.20). Adjusting for baseline differences between DAP and usual care participants and restricting analysis to DAP participants in whom delirium was detected did not alter the results.
Detection of delirium improved at the DAP sites, but the DAP had no effect on the persistence of delirium. This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities.
确定是否可以通过采用谵妄缓解方案（DAP）来缩短新发入住康复护理机构（PAC）患者的谵妄持续时间。
整群随机对照试验。
单一大都会地区的 8 个专业从事 PAC 的疗养院。
PAC 入院时患有谵妄的 457 名患者。
DAP 包括四个步骤：在 PAC 入院后 5 天内进行谵妄评估、评估和纠正常见的可逆性谵妄原因、预防谵妄并发症和恢复功能。
经培训的研究人员筛选符合条件的患者。使用代理同意书，根据《意识模糊评估法》定义患有谵妄的患者有资格参与。无论干预状态如何，研究人员在入组后 2 周和 1 个月时对所有患者进行了盲法评估。
DAP 地点的护士在 41%的参与者中检测到了谵妄，而常规护理地点为 12%（P<.001），并且在大多数检测到谵妄的参与者中完成了 DAP 记录，但 DAP 干预措施在 2 周时的两次测量（DAP 68% vs 常规护理 66%）和 1 个月时（DAP 60% vs 常规护理 51%）（调整后 P>.20）对谵妄的持续存在没有影响。调整 DAP 和常规护理参与者之间的基线差异，并将分析仅限于检测到谵妄的 DAP 参与者，并不会改变结果。
在 DAP 地点，谵妄的检测得到了改善，但 DAP 对谵妄的持续时间没有影响。这项有效性试验表明，在典型的 PAC 机构中，护士主导的 DAP 干预措施无效。
