支持急诊科认知障碍老年人护理质量的结构质量指标。

Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.

作者信息

Schnitker Linda M, Martin-Khan Melinda, Burkett Ellen, Brand Caroline A, Beattie Elizabeth R A, Jones Richard N, Gray Len C

机构信息

The Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia.

出版信息

Acad Emerg Med. 2015 Mar;22(3):273-84. doi: 10.1111/acem.12617.

DOI:10.1111/acem.12617

PMID:25754936

Abstract

OBJECTIVES

The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).

METHODS

A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria.

RESULTS

At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment.

CONCLUSIONS

This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.

摘要

目的

本研究旨在确定护理结构质量领域，并建立一套结构质量指标（SQIs），用于评估急诊科（ED）中认知障碍老年人的护理情况。

方法

采用结构化方法制定SQIs，包括：1）全面检索同行评审文献和灰色文献，重点是识别针对认知障碍老年患者护理结构的循证干预措施和现有的SQIs；2）开展一个咨询过程，让老年护理专家和流行病学方法专家（即咨询小组）参与，从而制定一套SQI草案；3）在8个急诊科对起草的SQIs进行实地测试，以完善SQI集；4）小组成员根据预先确定的纳入和排除标准，对最终纳入的SQIs进行独立投票。

结果

在该过程结束时，制定了5项针对急诊科认知障碍老年患者管理的SQIs：1）急诊科有一项政策，概述认知障碍老年人在急诊科护理期间的管理；2）急诊科有一项政策，概述与认知障碍老年人护理者相关的问题，包括在急诊科护理期间纳入（家庭）护理者的必要性；3）急诊科有一项政策，概述行为症状的评估和管理，特别提及认知障碍老年人；4）急诊科有一项政策，概述谵妄预防策略，包括评估患者的谵妄风险因素；5）急诊科有一项政策，概述认知障碍老年人的疼痛评估和管理。