University Hospital Basel, Switzerland.
University of West of Scotland, Scotland, UK.
Int J Nurs Stud. 2016 Jan;53:27-38. doi: 10.1016/j.ijnurstu.2015.08.003. Epub 2015 Aug 17.
Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear.
To determine the effects of DemDel, a comprehensive delirium management programme, in inpatient acute care elders with cognitive impairment.
This paper reports the quantitative part of a mixed methods study, comparing an intervention with treatment as usual using validated outcome measures. After training, ward nurses and physicians administered the intervention based on the DemDel algorithm that focused on delirium prevention, including an intensive systematic screening schedule for cognitive impairment and delirium, as well as comprehensive delirium management. The delirium management regimen included timely administration of pro re nata medication.
The study was conducted within four medical wards of an acute care university hospital in urban Switzerland.
A total of 268 patients with cognitive impairment participated in the pre/post comparison study. The intervention and treatment as usual groups consisted of 138 and 130 patients, respectively.
Eighty-seven (32.5%) out of 268 patients developed delirium, of whom 51 (58.6%) were of mixed, 10 (11.5%) hyperactive and 26 (29.9%) hypoactive delirium subtypes. Delirium appeared within the first five days after admission in 81.6% of cases. The 44 (31.9%) patients with delirium in the intervention group with systematic delirium management had less severe episodes of delirium and required medication for management than the 43 (33.1%) delirious patients in the control group. Intervention compliance was good on three of the four units.
The DemDel programme was effective with regard to improvement of outcomes associated with delirium in patients with cognitive impairment. The intervention was feasible and possible to be embedded within routine practice on four busy general medical wards.
研究估计，大约三分之一的谵妄发作是可以预防的，而在实践中，谵妄的预防和管理往往并不理想。虽然毫无疑问预防是可取的，但对于老年住院痴呆患者早期干预和治疗的益处证据尚不清楚。
确定综合性谵妄管理方案 DemDel 在认知障碍的住院急性护理老年人中的效果。
本文报告了一项混合方法研究的定量部分，该研究比较了干预组与常规治疗组使用验证后的结局测量指标的结果。在培训后，病房护士和医生根据 DemDel 算法实施干预，该算法侧重于谵妄预防，包括针对认知障碍和谵妄的强化系统筛查计划，以及全面的谵妄管理。谵妄管理方案包括及时给予按需药物治疗。
该研究在瑞士城市一所急性护理大学附属医院的四个内科病房进行。
共有 268 名认知障碍患者参加了预/后比较研究。干预组和常规治疗组分别有 138 名和 130 名患者。
268 名患者中有 87 名（32.5%）发生了谵妄，其中 51 名（58.6%）为混合性、10 名（11.5%）为兴奋型和 26 名（29.9%）为抑制型谵妄亚型。81.6%的病例在入院后 5 天内出现谵妄。在接受系统性谵妄管理的干预组中，44 名（31.9%）有谵妄的患者谵妄发作程度较轻，需要药物治疗的比例低于对照组的 43 名（33.1%）有谵妄的患者。在四个内科病房中的三个病房，干预措施的依从性较好。
DemDel 方案在改善认知障碍患者谵妄相关结局方面是有效的。该干预措施在四个繁忙的综合内科病房的常规实践中是可行和可能实施的。
