Department of Intensive Care, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, the Netherlands.
Nurs Crit Care. 2017 May;22(3):133-140. doi: 10.1111/nicc.12239. Epub 2016 Mar 20.
Delirium is a common form of vital organ dysfunction in intensive care unit (ICU) patients and is associated with poor outcomes. Adherence to guideline recommendations pertaining to delirium is still suboptimal.
We performed a survey aimed at identifying barriers for implementation that should be addressed in a tailored implementation intervention targeted at improved ICU delirium guideline adherence.
The survey was conducted among ICU professionals.
An online survey was conducted among 360 ICU health care professionals (nurses, physicians and delirium consultants) from six ICUs in the southwest of the Netherlands as part of a multicentre prospective implementation project [response rate: 64% of 565 invited; 283 (79%) were nurses].
Although the majority (83%) of respondents considered delirium a common and major problem in the ICU, we identified several barriers for implementation of a delirium guideline. The most important barriers were knowledge deficit, low delirium screening rate, lack of trust in the reliability of delirium screening tools, belief that delirium is not preventable, low familiarity with delirium guidelines, low satisfaction with physician-described delirium management, poor collaboration between nurses and physicians, reluctance to change delirium care practices, lack of time, disbelief that patients would receive optimal care when adhering to the guideline and the perception that the delirium guideline is cumbersome or inconvenient in daily practice.
Although ICU professionals consider delirium a serious problem, several important barriers to adhere to guidelines on delirium management are still present today.
Identification of implementation barriers for adherence to guidelines pertaining to delirium is feasible with a survey. Results of this study may help to design-targeted implementation strategies for ICU delirium management.
谵妄是重症监护病房（ICU）患者常见的重要器官功能障碍形式，与不良结局相关。遵循有关谵妄的指南建议的情况仍然不理想。
我们进行了一项调查，旨在确定实施过程中的障碍，这些障碍应在针对改善 ICU 谵妄指南依从性的定制实施干预中加以解决。
该调查是在 ICU 专业人员中进行的。
作为多中心前瞻性实施项目的一部分，我们在荷兰西南部的六个 ICU 中对 360 名 ICU 医护人员（护士、医生和谵妄顾问）进行了在线调查（应答率：565 名受邀者中的 64%；283 名[79%]为护士）。
尽管大多数（83%）受访者认为谵妄是 ICU 中的常见和主要问题，但我们确定了实施谵妄指南的几个障碍。最重要的障碍是知识不足、谵妄筛查率低、对谵妄筛查工具的可靠性缺乏信任、认为谵妄不可预防、对谵妄指南的熟悉程度低、对医生描述的谵妄管理满意度低、护士与医生之间协作不佳、不愿改变谵妄护理实践、缺乏时间、不相信患者在遵守指南时会得到最佳护理以及认为谵妄指南在日常实践中繁琐或不方便。
尽管 ICU 专业人员认为谵妄是一个严重的问题，但目前仍存在一些重要的障碍，难以遵循有关谵妄管理的指南。
使用调查可以确定遵循谵妄管理指南的实施障碍。本研究的结果可能有助于为 ICU 谵妄管理设计有针对性的实施策略。
Zotero 插件