老年住院澳大利亚人认知障碍筛查的记录文件：前瞻性临床记录审核。

Documentation of cognitive impairment screening amongst older hospitalised Australians: a prospective clinical record audit.

机构信息

Hunter New England Local Health District, Newcastle, NSW, Australia.

School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.

出版信息

BMC Geriatr. 2023 Oct 18;23(1):672. doi: 10.1186/s12877-023-04394-z.

DOI:10.1186/s12877-023-04394-z

PMID:37853320

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10583351/

Abstract

BACKGROUND

Failure to detect cognitive impairment (CI) in hospitalised older inpatients has serious medical and legal implications, including for the implementation of care planning. This mixed methods study aimed to determine amongst hospital in-patients aged ≥ 65 years: (1) Rates of documentation of screening for CI, including the factors associated with completion of screening; (2) Rates of undocumented CI amongst patients who had not received screening during their admission; (3) Healthcare provider practices and barriers related to CI screening.

METHODS

A mixed methods study incorporating a clinical audit and interviews with healthcare providers was conducted at one Australian public hospital. Patients were eligible for inclusion if they were aged 65 years and older and were admitted to a participating ward for a minimum of 48 h. Patient characteristics, whether CI screening had been documented, were extracted using a template. Patients who had not been screened for CI completed the Montreal Cognitive Assessment (MoCA) to determine cognitive status. Interviews were conducted with healthcare providers to understand practices and barriers to screening for CI.

RESULTS

Of the 165 patients included, 34.5% (n = 57) had screening for CI documented for their current admission. Patients aged > 85 years and those with two or more admissions had greater odds of having CI screening documented. Among patients without CI screening documented, 72% (n = 78) were identified as cognitively impaired. While healthcare providers agreed CI screening was beneficial, they identified lack of time and poor knowledge as barriers to undertaking screening.

CONCLUSIONS

CI is frequently unrecognised in the hospital setting which is a missed opportunity for the provision of appropriate care. Future research should identify feasible and effective strategies to increase implementation of CI screening in hospitals.

摘要

背景

未能在住院老年患者中发现认知障碍 (CI) 会带来严重的医疗和法律后果，包括对护理计划的实施。本混合方法研究旨在确定在年龄≥65 岁的住院患者中：(1) 筛查 CI 的记录率，包括与筛查完成相关的因素；(2) 在住院期间未接受筛查的患者中未记录到 CI 的比率；(3) 与 CI 筛查相关的医疗保健提供者实践和障碍。

方法

在一家澳大利亚公立医院进行了一项混合方法研究，纳入了临床审计和对医疗保健提供者的访谈。符合纳入标准的患者为年龄≥65 岁且在参与病房至少住院 48 小时的患者。使用模板提取患者特征，包括是否记录了 CI 筛查。未进行 CI 筛查的患者完成蒙特利尔认知评估 (MoCA) 以确定认知状态。对医疗保健提供者进行访谈，以了解筛查 CI 的实践和障碍。

结果

在纳入的 165 名患者中，34.5%（n=57）记录了当前住院期间的 CI 筛查。年龄>85 岁和有两次或两次以上入院的患者更有可能记录 CI 筛查。在未记录 CI 筛查的患者中，72%（n=78）被确定为认知受损。尽管医疗保健提供者认为 CI 筛查有益，但他们认为缺乏时间和知识有限是进行筛查的障碍。