Gandhi Ishita, Sharma Reena
Department of Palliative Medicine, CanSupport, New Delhi, India.
Indian J Palliat Care. 2023 Jan-Mar;29(1):70-74. doi: 10.25259/IJPC_48_2022. Epub 2022 Sep 7.
Delirium increases distress in patients and caregivers and often leads to hospitalisation and increased health-care costs. It is early diagnosis and management improves the quality of life (QoL) of advanced cancer patients as well as their families. This quality improvement (QI) project aimed at increasing delirium assessment in poor performance advanced cancer patients receiving palliative homecare.
The A3 methodology for QI was used. Our SMART goal was to increase the assessment of delirium in poor performance advanced cancer patients from 25% to 50%. The Fishbone and Pareto analysis helped to determine the reasons for low assessment rates. A validated screening tool for delirium assessment was selected and the homecare team doctors and nurses were trained to use it. A flier was designed to help educate families about delirium.
Regular use of the tool helped to increase delirium assessment from an initial 25-50% at the time of project completion. The homecare teams learnt the importance of early delirium diagnosis and the need for regular delirium screening. Family caregivers were empowered through education and use of fliers.
The QI project helped to improve delirium assessment and leading to improved QoL of patients and their caregivers. Regular training and awareness and continued use of a validated screening tool should help to sustain the results.
谵妄会增加患者及其照顾者的痛苦，常常导致住院治疗及医疗费用增加。早期诊断和管理可改善晚期癌症患者及其家人的生活质量（QoL）。本质量改进（QI）项目旨在提高接受姑息家庭护理的身体状况较差的晚期癌症患者的谵妄评估率。
采用QI的A3方法。我们的明确可衡量的目标是将身体状况较差的晚期癌症患者的谵妄评估率从25%提高到50%。鱼骨图分析和帕累托分析有助于确定评估率低的原因。选择了一种经过验证的谵妄评估筛查工具，并对家庭护理团队的医生和护士进行培训以使用该工具。设计了一份传单，以帮助向家属宣传谵妄知识。
定期使用该工具有助于将谵妄评估率从项目开始时的25%提高到项目完成时的50%。家庭护理团队认识到早期谵妄诊断的重要性以及定期进行谵妄筛查的必要性。通过教育和发放传单，增强了家庭照顾者的能力。
该QI项目有助于改善谵妄评估，从而提高患者及其照顾者的生活质量。定期培训、提高意识以及持续使用经过验证的筛查工具应有助于维持这一成果。
