在线学习课程能否改善对有谵妄风险的老年人的护理：一项阶梯式楔形整群随机试验。

Can an e-learning course improve nursing care for older people at risk of delirium: a stepped wedge cluster randomised trial.

作者信息

van de Steeg Lotte, IJkema Roelie, Langelaan Maaike, Wagner Cordula

机构信息

NIVEL, Netherlands institute for health services research, P,O, Box 1568, Utrecht 3500 BN, The Netherlands.

出版信息

BMC Geriatr. 2014 May 27;14:69. doi: 10.1186/1471-2318-14-69.

DOI:10.1186/1471-2318-14-69

PMID:24884739

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4046094/

Abstract

BACKGROUND

Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes. Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care. The objective of the study was to determine whether e-learning can be an effective means of improving implementation of a quality improvement project in delirium care. This project aims primarily at improving the early recognition of older patients who are at risk of delirium.

METHODS

In a stepped wedge cluster randomised trial an e-learning course on delirium was introduced, aimed at nursing staff. The trial was conducted on general medical and surgical wards from 18 Dutch hospitals. The primary outcome measure was the delirium risk screening conducted by nursing staff, measured through monthly patient record reviews. Patient records from patients aged 70 and over admitted onto wards participating in the study were used for data collection. Data was also collected on the level of delirium knowledge of these wards' nursing staff.

RESULTS

Records from 1,862 older patients were included during the control phase and from 1,411 patients during the intervention phase. The e-learning course on delirium had a significant positive effect on the risk screening of older patients by nursing staff (OR 1.8, p-value <0.01), as well as on other aspects of delirium care. The number of patients diagnosed with delirium was reduced from 11.2% in the control phase to 8.7% in the intervention phase (p = 0.04). The e-learning course also showed a significant positive effect on nurses' knowledge of delirium.

CONCLUSIONS

Nurses who undertook a delirium e-learning course showed a greater adherence to the quality improvement project in delirium care. This improved the recognition of patients at risk and demonstrated that e-learning can be a valuable instrument for hospitals when implementing improvements in delirium care.

TRIAL REGISTRATION

The Netherlands National Trial Register (NTR).

TRIAL NUMBER

NTR2885.

摘要

背景

谵妄在老年住院患者中频繁发生，并与多种不良后果相关。医疗保健专业人员的无知以及未能识别谵妄患者被认为是护理质量差的可能原因。本研究的目的是确定电子学习是否可以成为改善谵妄护理质量改进项目实施的有效手段。该项目主要旨在提高对有谵妄风险的老年患者的早期识别。

方法

在一项阶梯式楔形整群随机试验中，针对护理人员引入了一门关于谵妄的电子学习课程。该试验在荷兰18家医院的普通内科和外科病房进行。主要结局指标是护理人员进行的谵妄风险筛查，通过每月审查患者记录来衡量。纳入参与研究病房的70岁及以上患者的病历用于数据收集。还收集了这些病房护理人员的谵妄知识水平数据。

结果

在对照阶段纳入了1862名老年患者的记录，在干预阶段纳入了1411名患者的记录。关于谵妄的电子学习课程对护理人员对老年患者的风险筛查有显著的积极影响（比值比1.8，p值<0.01），以及对谵妄护理的其他方面也有积极影响。诊断为谵妄的患者数量从对照阶段的11.2%降至干预阶段的8.7%（p = 0.04）。电子学习课程对护士的谵妄知识也有显著的积极影响。