Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Intern Med J. 2013 Mar;43(3):270-7. doi: 10.1111/j.1445-5994.2012.02840.x.
Clinical practice guidelines have been developed to improve screening, prevention and management of delirium.
To implement delirium guidelines in general medical patients to reduce incidence and duration of delirium and improve outcomes in delirious patients.
Implementation was led by a multidisciplinary team of clinicians and project staff on one medical ward. Evaluation was undertaken as a controlled trial in patients aged 65 years or older with/at risk of delirium, compared with a control medical ward. Interventions included risk screening, delirium detection, multidisciplinary education, ward modifications including a four-bed delirium bay, behaviour and medication protocols, and use of nursing assistant and volunteers. Primary outcome measures were incidence and duration of delirium; secondary outcomes were length of stay, mortality, falls and discharge destination in delirious subgroup. Process measures included ward moves, use of neuroleptics, allied health review and delirium bay use.
Of 206 consenting older medical patients, 22% were delirious at admission and 44% were at risk. No incident cases of delirium were identified. In the delirious subgroup, significantly fewer intervention participants were discharged with persistent delirium (32% vs 71%, P = 0.016), with trends to reduced inpatient mortality (0% vs 18.5%, P = 0.07) and falls (11% vs 22%, P = 0.16), at the expense of a longer medical ward stay (16 days vs 8 days, P = 0.01).
Low incidence of new delirium may reflect the established interdisciplinary care environment. Improved outcomes in the delirious group are encouraging although implementation was costly, including increased length of acute ward stay.
临床实践指南的制定是为了改善谵妄的筛查、预防和管理。
在普通内科患者中实施谵妄指南，以降低谵妄的发生率和持续时间，并改善谵妄患者的结局。
实施由一个多学科临床医生和项目工作人员团队在一个内科病房领导。评估是在年龄 65 岁或以上有/有谵妄风险的患者中进行的，与对照内科病房进行对照试验。干预措施包括风险筛查、谵妄检测、多学科教育、病房改造，包括一个四人谵妄病房、行为和药物治疗方案，以及使用护理助理和志愿者。主要结局指标是谵妄的发生率和持续时间；次要结局指标是谵妄亚组的住院时间、死亡率、跌倒和出院去向。过程测量包括病房转移、使用神经阻滞剂、联合健康审查和谵妄病房使用。
在 206 名同意的老年内科患者中，22%在入院时出现谵妄，44%有谵妄风险。没有新发生的谵妄病例。在谵妄亚组中，干预组中持续性谵妄出院的患者明显减少（32%对 71%，P = 0.016），住院死亡率（0%对 18.5%，P = 0.07）和跌倒（11%对 22%，P = 0.16）的趋势也有所降低，代价是急性病房住院时间延长（16 天对 8 天，P = 0.01）。
新发生的谵妄发生率低可能反映了既定的跨学科护理环境。尽管实施成本高昂，包括急性病房住院时间延长，但谵妄组的结局改善令人鼓舞。
