Center for Clinical & Professional Development, Maine Medical Center, Portland, ME, USA.
Center of Nursing Research and Quality Outcomes, Maine Medical Center, Portland, ME, USA.
J Clin Nurs. 2018 Apr;27(7-8):e1429-e1441. doi: 10.1111/jocn.14259. Epub 2018 Mar 13.
To describe and compare identification of delirium, length of stay and discharge locations in two patient samples of falls, before and after an organisation-wide interprofessional delirium education and practice change along with implementation of a policy.
Delirium is a common and severe problem for hospitalised patients, with occurrence ranging from 14%-56%, morbidity and mortality from 25%-33%. Recent studies report that 73%-96% of patients who fell during a hospital stay had symptoms of delirium; however, the delirium went undiagnosed and untreated in 75% of the cases.
A descriptive, retrospective observational study using a pre/postdesign.
Two chart reviews were performed on patient falls as identified in the hospital safety reporting system in 2009-2010 (98 fallers) and 2012 (108 fallers). An organisation-wide education was planned and implemented with monitoring of policy compliance.
After the education, documentation of the "diagnosis of delirium" and "no evidence of delirium" increased from 14.3%-29.5% and from 27.6%-44.4%. The documentation of "evidence of delirium" decreased significantly from 58.2%-25.9% (p < .001). The confusion assessment method (CAM) identified the diagnosis of delirium at 76% accuracy. The length of stay decreased by 7.3 days. The fall rates in 2011 and 2012 were 3.01 and 2.82 falls per 1,000 patient days and in 2013 decreased to 2.16.
The results indicate that improving delirium recognition and treatment through interprofessional education can reduce falls and length of stay.
The results demonstrate that when staff learn to prevent, identify, manage and document delirium more accurately the fall rate decreases. The practice change, including the use of CAM, was sustained by continuous auditing including re-education, and the re-enforcement of learning along with the implementation of a policy.
描述并比较两个跌倒患者样本在进行组织范围的跨专业谵妄教育和实践改变以及实施政策前后，谵妄的识别、住院时间和出院地点。
谵妄是住院患者常见且严重的问题，发生率为 14%-56%，发病率和死亡率为 25%-33%。最近的研究报告称，73%-96%在住院期间跌倒的患者有谵妄症状；然而，在 75%的病例中，谵妄未被诊断和治疗。
使用预/后设计进行描述性、回顾性观察研究。
对 2009-2010 年（98 名跌倒者）和 2012 年（108 名跌倒者）医院安全报告系统中识别的患者跌倒进行了两次病历回顾。计划并实施了组织范围的教育，并监测了政策的遵守情况。
教育后，“谵妄诊断”和“无谵妄证据”的记录从 14.3%-29.5%和 27.6%-44.4%增加。“谵妄证据”的记录显著从 58.2%-25.9%减少（p<.001）。混乱评估方法（CAM）以 76%的准确率识别出谵妄诊断。住院时间缩短了 7.3 天。2011 年和 2012 年的跌倒率分别为每 1000 个患者天 3.01 次和 2.82 次，2013 年下降至 2.16 次。
结果表明，通过跨专业教育提高谵妄识别和治疗能力可以降低跌倒率和住院时间。
结果表明，当工作人员学会更准确地预防、识别、管理和记录谵妄时，跌倒率会下降。实践改变，包括使用 CAM，通过持续审计得到维持，包括重新教育和学习强化，以及政策的实施。
