降低 ICU 意识模糊评估法的不恰当无法评估率。
Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit.
机构信息
Joshua T. Swan is an assistant professor of pharmacy practice at the College of Pharmacy and Health Sciences, Texas Southern University, a clinical pharmacist specialist at Houston Methodist Hospital, and a clinical research scholar in the Center for Outcomes Research in the Department of Surgery at Houston Methodist Research Institute, Houston, Texas.
出版信息
Am J Crit Care. 2014 Jan;23(1):60-9. doi: 10.4037/ajcc2014567.
BACKGROUND
The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for diagnosing delirium in the ICU and yields 1 of 3 ratings: positive, negative, and unable to assess (UTA). It was hypothesized that an educational campaign focused on establishing patients' arousal as comatose versus noncomatose before initiating the CAM-ICU would decrease the incidence of inappropriate UTA ratings.
OBJECTIVES
To compare the incidence of inappropriate UTA ratings before and after an educational campaign.
METHODS
An interventional, quasi-experimental study was conducted in a surgical ICU at a tertiary academic medical center. A nursing educational campaign was conducted from March 1 to March 7, 2012. Patients admitted to the surgical ICU from December 25, 2011 through January 25, 2012 were included in the baseline cohort, and patients admitted from March 9 through April 9, 2012 were included in the posteducation cohort. Inclusion criteria were admission to the surgical ICU for at least 24 hours and at least 1 CAM-ICU assessment.
RESULTS
The baseline cohort included 93 patients and the posteducation cohort included 96 patients. Patients were 41% less likely to receive an inappropriate UTA rating after the educational campaign (32% [30 of 93] baseline vs 19% [18 of 96], P = .03). Patients with concurrent mechanical ventilation were more likely to receive an inappropriate UTA rating in the baseline cohort (odds ratio, 30.7; 95% CI, 8.9-105.9; P < .001) and the posteducation cohort (odds ratio, 15.5; 95% CI, 4.1-59.5; P < .001).
CONCLUSION
The educational campaign decreased the incidence of inappropriate UTA ratings.
背景
重症监护病房意识模糊评估法（CAM-ICU）是一种经过验证的用于诊断 ICU 谵妄的工具，其结果为阳性、阴性和无法评估（UTA）之一。研究假设，在启动 CAM-ICU 之前，针对患者的意识状态是昏迷还是非昏迷进行教育活动，将降低不恰当 UTA 评分的发生率。
目的
比较教育活动前后不恰当 UTA 评分的发生率。
方法
这是一项在三级学术医疗中心的外科重症监护病房进行的干预性、准实验研究。2012 年 3 月 1 日至 3 月 7 日开展了护理教育活动。将 2011 年 12 月 25 日至 2012 年 1 月 25 日期间收入外科重症监护病房的患者纳入基线队列，将 2012 年 3 月 9 日至 4 月 9 日期间收入的患者纳入教育后队列。纳入标准为至少入住外科重症监护病房 24 小时且至少进行 1 次 CAM-ICU 评估。
结果
基线队列纳入 93 例患者，教育后队列纳入 96 例患者。教育活动后，患者接受不恰当 UTA 评分的可能性降低了 32%（基线组为 30%[93 例中的 30 例]，教育后组为 19%[96 例中的 18 例]，P =.03）。基线组和教育后组中，同时接受机械通气的患者更有可能接受不恰当 UTA 评分（比值比，30.7；95%置信区间，8.9-105.9；P <.001；比值比，15.5；95%置信区间，4.1-59.5；P <.001）。
结论
教育活动降低了不恰当 UTA 评分的发生率。
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