The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA.
Mount Nittany Physician Group, Mount Nittany Medical Center, State College, Pennsylvania, USA.
J Am Geriatr Soc. 2021 May;69(5):1349-1356. doi: 10.1111/jgs.17026. Epub 2021 Jan 20.
BACKGROUND/OBJECTIVES: An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+).
A qualitative descriptive design using observational data collection and brief semi-structured interviews.
An urban academic medical center and a community teaching hospital.
Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs).
Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations.
The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening.
This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
背景/目的：需要一种有效且高效的谵妄识别方案，以改善老年人的健康状况并降低医疗保健成本。本研究描述了与超简短混乱评估方法（UB-CAM）实施相关的障碍和促进因素，该方法是一种快速两步的谵妄识别方案（超简短筛查，阳性者进行 CAM），已在住院老年人（70 岁以上）中进行了现场测试。
采用定性描述设计，使用观察数据收集和简短的半结构化访谈。
城市学术医疗中心和社区教学医院。
参与者包括 50 名医师医院医生、189 名注册护士和 83 名护理助理（NA）。
现场研究人员根据修改后的多层次实施框架，在参与者实施 UB-CAM 时（n=767）收集观察数据。对五个观察类别进行了主题分析：结构、组织、患者、临床医生和创新。与临床医生进行的现场记录和简短的半结构化访谈（n=231）探讨了该方案的实用性、可接受性和可行性，并补充了观察结果。
UB-CAM 得到了所有三种临床医生类型的普遍好评。六个主题描述了实施 UB-CAM 的障碍和/或促进因素：（1）物理环境和环境；（2）实践环境；（3）融入角色；（4）适应技术；（5）患者反应；（6）系统评估。六个主题的组成和相互作用决定了该主题是表达为障碍还是促进因素，这肯定了在实施系统层面的谵妄筛查时背景的重要性。
这是第一项测试两步谵妄识别过程并让护理助理参与筛查的研究之一，研究结果表明临床医生总体上支持谵妄识别，并描述了实施和评估谵妄筛查需要采取多方面、有背景和系统性的方法。
