Fick Donna M, Inouye Sharon K, McDermott Caroline, Zhou Wenxiao, Ngo Long, Gallagher Jackie, McDowell Jane, Penrod Janice, Siuta Jonathan, Covaleski Thomas, Marcantonio Edward R
J Gerontol Nurs. 2018 May 1;44(5):18-24. doi: 10.3928/00989134-20180302-01. Epub 2018 Apr 2.
The feasibility and acceptability of a two-step screening protocol for delirium identification was pilot tested. Step 1, a screening tool, comprises two items: "Please tell me the day of the week," and "Please tell me the months of the year backwards starting with December." If either/both items are incorrect, Step 2, a 3-minute diagnostic assessment, follows. Trained researchers enrolled 24 hospitalized older adults and identified 22% to be delirious after a reference standard assessment. Thereafter, physicians and RNs completed the two-step protocol, whereas certified nursing assistants (CNAs) completed the screener only, on the same patients. All three clinical assessments were successfully completed in 100% of enrolled participants and within the target 2-hour time window in 91%. The screener and two-step protocol achieved high sensitivities and specificities in RNs, CNAs, and physicians. Qualitative information on barriers to and facilitators of implementation was also collected. Nurses and other clinicians can feasibly implement this ultra-brief screener and two-step protocol, which holds promise to improve delirium identification. [Journal of Gerontological Nursing, 44(5), 18-24.].
对一种用于谵妄识别的两步筛查方案的可行性和可接受性进行了试点测试。第一步是一种筛查工具，包括两个项目：“请告诉我今天是星期几”，以及“请从12月开始倒着告诉我一年中的月份”。如果任何一个/两个项目回答错误，则进入第二步，即3分钟的诊断评估。经过培训的研究人员招募了24名住院的老年人，在经过参考标准评估后，确定22%的人患有谵妄。此后，医生和注册护士完成了两步方案，而认证护理助理（CNA）只对相同的患者完成了筛查部分。100%的入组参与者成功完成了所有三项临床评估，91%的参与者在目标2小时时间窗口内完成。该筛查工具和两步方案在注册护士、认证护理助理和医生中都具有较高的敏感性和特异性。还收集了关于实施障碍和促进因素的定性信息。护士和其他临床医生可以切实可行地实施这种超简短筛查工具和两步方案，这有望改善谵妄的识别。[《老年护理杂志》，44(5)，18 - 24。]
