一种针对重症监护中谵妄预防的多方面方法。
A multifaceted approach to prevention of delirium on intensive care.
作者信息
Hanison James, Conway Daniel
机构信息
Manchester Royal Infirmary.
出版信息
BMJ Qual Improv Rep. 2015 Sep 11;4(1). doi: 10.1136/bmjquality.u209656.w4000. eCollection 2015.
Delirium is a frequent complication of critical illness with an increased risk of death which is difficult to treat effectively. We describe a seven year quality improvement programme that aimed to reduce rates of delirium on intensive care (ICU). We completed two PDSA programmes with a number of changes including alterations to sedation practice and environmental changes to the ICU itself. Rates of delirium reduced from 70% to 44% after the first cycle of change. Rates of delirium were further reduced to 29% after the second cycle of change. The rates are now lower than predicted by the validated prediction tool PRE-DELIRIC. This project demonstrates that a multifaceted approach to prevention of delirium on ICU can deliver sustained reductions in rates of delirium. The impact of the second cycle of change was less than the first, suggesting that further reductions may prove more challenging.
谵妄是危重病常见的并发症，死亡风险增加，且难以有效治疗。我们描述了一项为期七年的质量改进计划，旨在降低重症监护病房（ICU）的谵妄发生率。我们完成了两个计划-实施-检查-行动（PDSA）项目，进行了多项改变，包括调整镇静措施以及对ICU本身的环境进行改变。在第一轮改变后，谵妄发生率从70%降至44%。在第二轮改变后，谵妄发生率进一步降至29%。目前该发生率低于经过验证的预测工具PRE-DELIRIC所预测的水平。该项目表明，采用多方面方法预防ICU中的谵妄可使谵妄发生率持续降低。第二轮改变的影响小于第一轮，这表明进一步降低发生率可能更具挑战性。
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