Davis Jessica, Berry Karen, McIntyre Rebecca, Conway Daniel, Thomas Anthony, Hanison James
Greater Manchester Critical Care Network, Critical Care Skills Institute, Old St Mary's Hospital, Manchester, UK.
J Intensive Care Soc. 2021 May;22(2):120-126. doi: 10.1177/1751143720912700. Epub 2020 Mar 26.
Delirium is a common complication of critical illness with a significant impact on patient morbidity and mortality. The Greater Manchester Critical Care Network established the Delirium Reduction Working Group in 2015. This article describes a region-wide delirium improvement project launched by that group.
Multiple Plan-Do-Study-Act cycles were undertaken. Cycle 1: April 2015 demonstrated only 48% of patients had a formal delirium screen. Following this a network-wide event took place and the Delirium Standards for the Greater Manchester Critical Care Network were produced. Cycle 2: May 2016 quarterly audits across the network monitored compliance against the agreed standards. Group events involved implementation of a delirium care bundle, sharing best practice, educating staff and providing guidance on the management of delirium. Cycle 3: November 2016 quarterly audit continued and a regional delirium study day was rolled out across the region.
We have 14 different units across our network, all of which have participated in the audit. The first audit showed a delirium point prevalence of 28%, subsequent point prevalence audits demonstrated rates as low as 13%. There has also been an improvement in the use of delirium screening tools. In the first audit 37% of patients had two delirium screens in 24 h, this has increased to 60% in the latest audit. Improvements were also made in availability of sensory aids and pain assessments.
The project has demonstrated the feasibility of delivering a coordinated delirium improvement project across multiple critical care units.
谵妄是危重症常见的并发症，对患者的发病率和死亡率有重大影响。大曼彻斯特重症监护网络于2015年成立了谵妄减少工作组。本文描述了该小组发起的一项全区域谵妄改善项目。
开展了多个计划-实施-研究-改进循环。循环1：2015年4月显示只有48%的患者进行了正式的谵妄筛查。在此之后，开展了一次全网络活动，并制定了大曼彻斯特重症监护网络的谵妄标准。循环2：2016年5月，对全网络进行季度审核，监测对商定标准的遵守情况。小组活动包括实施谵妄护理套餐、分享最佳实践、培训工作人员以及提供谵妄管理指南。循环3：2016年11月继续进行季度审核，并在全区域开展了一次区域性谵妄研究日活动。
我们的网络中有14个不同的单位，所有单位都参与了审核。首次审核显示谵妄时点患病率为28%，随后的时点患病率审核显示患病率低至13%。谵妄筛查工具的使用也有所改善。在首次审核中，37%的患者在24小时内进行了两次谵妄筛查，在最近一次审核中，这一比例已增至60%。在感官辅助设备的可用性和疼痛评估方面也有改进。
该项目证明了在多个重症监护病房开展协调一致的谵妄改善项目的可行性。
