实施ABCDE集束化护理对重症监护病房患者谵妄发生率的影响。
Effect of ABCDE Bundle Implementation on Prevalence of Delirium in Intensive Care Unit Patients.
作者信息
Bounds Mandy, Kram Stacey, Speroni Karen Gabel, Brice Kim, Luschinski Mary Anne, Harte Stephanie, Daniel Marlon G
机构信息
Mandy Bounds is a former nurse manager at University of Maryland Shore Medical Center at Dorchester, Cambridge, Maryland. Stacey Kram is a former nurse manager at University of Maryland Shore Regional Health, Easton, Maryland. Karen Gabel Speroni is chair of the nursing research council, University of Maryland Shore Regional Health. Kim Brice is an intensive care unit (ICU)/telemetry clinical educator/ICU staff nurse at University of Maryland Shore Medical Center at Easton, Easton, Maryland. Mary Anne Luschinski is an ICU staff nurse at University of Maryland Shore Medical Center at Easton. Stephanie Harte is a former physical therapist at University of Maryland Shore Medical Center at Dorchester and Easton. Marlon G. Daniel is a biostatistician at University of Maryland Shore Regional Health.
出版信息
Am J Crit Care. 2016 Nov;25(6):535-544. doi: 10.4037/ajcc2016209.
BACKGROUND
The ABCDE bundle incorporates multidisciplinary measures to improve and/or preserve patients' physical, functional, and neurocognitive status through awakening and breathing coordination, delirium prevention and management, and early physical mobility.
OBJECTIVES
To quantify the prevalence and duration of delirium in patients in the intensive care unit (ICU) before and after implementation of the ABCDE bundle.
METHODS
Delirium prevalence was defined as the percentage of patients who had at least 1 positive delirium score on the Intensive Care Delirium Screening Checklist (ICDSC) during the ICU stay; delirium duration was the number of days during the ICU stay that a positive ICDSC score was noted. Retrospective data were collected from before and after implementation of the ABCDE bundle.
RESULTS
Of the 159 records reviewed (80 before and 79 after bundle implementation), most were for white men (mean age, 66.3 years). After implementation of the ABCDE bundle, the prevalence of delirium decreased significantly (from 38% to 23%, P = .01) and the mean number of days of delirium decreased significantly (from 3.8 to 1.72 days, P < .001). The number of patients with delirium-free stays increased after bundle implementation.
CONCLUSIONS
Implementation of the ABCDE bundle led to significant decreases in the prevalence and duration of delirium in ICU patients.
背景
ABCDE集束化治疗包含多学科措施，旨在通过唤醒与呼吸协调、谵妄预防与管理以及早期身体活动，改善和/或维持患者的身体、功能及神经认知状态。
目的
量化重症监护病房（ICU）患者在实施ABCDE集束化治疗前后谵妄的患病率及持续时间。
方法
谵妄患病率定义为ICU住院期间在重症监护谵妄筛查清单（ICDSC）上至少有1次阳性谵妄评分的患者百分比；谵妄持续时间为ICU住院期间记录到阳性ICDSC评分的天数。收集ABCDE集束化治疗实施前后的回顾性数据。
结果
在审查的159份记录中（集束化治疗实施前80份，实施后79份），大多数是白人男性（平均年龄66.3岁）。实施ABCDE集束化治疗后，谵妄患病率显著降低（从38%降至23%，P = .01），谵妄平均天数显著减少（从3.8天降至1.72天，P < .001）。集束化治疗实施后无谵妄住院的患者数量增加。
结论
实施ABCDE集束化治疗可显著降低ICU患者谵妄的患病率及持续时间。
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