Brooks Paula, Spillane Jeffrey J, Dick Karen, Stuart-Shor Eileen
AORN J. 2014 Feb;99(2):257-73; quiz 274-6. doi: 10.1016/j.aorn.2013.12.009.
Postoperative delirium is one of the most common adverse outcomes in elderly patients undergoing surgery and is associated with increased morbidity, length of stay, and patient care costs. The purpose of this quality improvement project was to evaluate the effectiveness of a multicomponent strategy to identify and treat general surgical patients 65 years of age or older at risk for and who develop postoperative delirium at Cape Cod Hospital, a community hospital in southern New England. We evaluated 96 patients using the Mini-Cog assessment tool preoperatively and the Confusion Assessment Method (CAM) delirium screening tool or CAM-Intensive Care Unit (CAM-ICU) assessment tool postoperatively. Patients who tested positive during preoperative assessment underwent a postoperative delirium management protocol. We summarized data using descriptive statistics. The results showed an association between compliance and outcomes. High compliance with implementation of CAM and CAM-ICU assessment tools resulted in increased identification of postoperative delirium in the older surgical population. The use of screening tools helped facilitate early identification of postoperative delirium in elderly surgical patients.
术后谵妄是老年手术患者最常见的不良后果之一，与发病率增加、住院时间延长及患者护理费用增加相关。本质量改进项目的目的是评估一种多组分策略的有效性，该策略用于识别和治疗新英格兰南部一家社区医院科德角医院65岁及以上有术后谵妄风险并发生术后谵妄的普通外科患者。我们术前使用简易认知评估工具对96例患者进行评估，术后使用谵妄评估方法（CAM）谵妄筛查工具或CAM重症监护病房（CAM-ICU）评估工具。术前评估呈阳性的患者接受术后谵妄管理方案。我们使用描述性统计方法汇总数据。结果显示依从性与结局之间存在关联。对CAM和CAM-ICU评估工具实施的高依从性导致在老年手术人群中术后谵妄的识别增加。筛查工具的使用有助于早期识别老年外科患者的术后谵妄。
