Volland Jennifer, Fisher Anna, Drexler Diane
Jennifer Volland, DHA, RN, CPHQ, NEA-BC, FACHE, is vice president of Program Development at National Research Corporation, Omaha, Nebraska. Anna Fisher, DHA, CDP, is director of Education and Quality at Hillcrest Health Services, Bellevue, Nebraska. Diane Drexler, MBA, BSN, RN, FACHE, is chief nursing officer at the Yavapai Regional Medical Center, Prescott, Arizona.
Dimens Crit Care Nurs. 2015 Sep-Oct;34(5):259-64. doi: 10.1097/DCC.0000000000000133.
: Longer stays in the intensive care unit (ICU) can be an opportunistic battlefield where not only is the length of stay longer, but also there is increased time that lapses with the potential for a patient fall, nosocomial infection, urinary tract infection, and other untoward events (http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf; ASHRM Forum. 2014;Q3:10-14). As such, the push has become for shorter lengths of stay whenever possible. Delirium and dementia are 2 conditions that the ICU clinician must remain diligent in monitoring for status changes. Delirium poses the threat of longer-term undesirable outcomes and is a potential inherent risk in the care delivered. It rises to the level of a medical emergency that can be deadly but, when caught early, can be treated and resolved (Science Daily, September 16, 2013). Setting expectations with families, providing adequate education, and involving them in a holistic view of patient-centered care can help toward the detection of differences that may occur from an ICU stay. Interventions the ICU clinician can take for increasing self, patient, and family awareness to decrease risk and improve outcomes and ways to deepen family engagement in these populations are explored with practical applications.
在重症监护病房（ICU）停留时间延长可能成为一个机会主义战场，不仅停留时间更长，而且患者跌倒、医院感染、尿路感染和其他不良事件发生的潜在时间也会增加（http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf；《美国医疗风险管理协会论坛》。2014年；第3季度：10 - 14页）。因此，只要有可能，就一直在推动缩短住院时间。谵妄和痴呆是重症监护病房临床医生必须持续密切监测其状态变化的两种情况。谵妄会带来长期不良后果的威胁，是所提供护理中潜在的固有风险。它上升到了一种可能致命的医疗紧急情况的程度，但如果早期发现，可以进行治疗并得到解决（《科学日报》，2013年9月16日）。与家属设定预期、提供充分的教育，并让他们参与以患者为中心的整体护理，可以有助于发现因在重症监护病房停留而可能出现的差异。本文探讨了重症监护病房临床医生为提高自身、患者和家属的意识以降低风险、改善结果可采取的干预措施，以及加深家属对这些人群参与度的方法，并给出了实际应用案例。
