دورية أكاديمية
أعرض في EDS

Nurse-Driven Assessment, Prevention, and Management of Delirium on an Acute Inpatient Neurology Unit.

التفاصيل البيبلوغرافية
العنوان: Nurse-Driven Assessment, Prevention, and Management of Delirium on an Acute Inpatient Neurology Unit.
المؤلفون: Francisco MA; Department of Evidence Based Practice and Research (Ms Francisco) and Center for Clinical Professional Practice (Dr Meletis), University of Chicago Medical Center (Mr Gesell and Dr Bohr), Chicago, Illinois; Biological Sciences Division (Dr Bohr) and Section of Geriatrics and Palliative Medicine, Department of Medicine (Dr Gleason), The University of Chicago Medicine, Chicago, Illinois., Gesell T, Meletis S, Bohr NL, Gleason LJ
المصدر: Journal of nursing care quality [J Nurs Care Qual] 2022 Oct-Dec 01; Vol. 37 (4), pp. 334-341. Date of Electronic Publication: 2022 Apr 28.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9200672 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1550-5065 (Electronic) Linking ISSN: 10573631 NLM ISO Abbreviation: J Nurs Care Qual Subsets: MEDLINE
أسماء مطبوعة: Publication: 2003- : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Frederick, MD : Aspen Publishers, c1991-
مواضيع طبية MeSH: Delirium*/diagnosis , Delirium*/prevention & control , Neurology* , Nurses*, Adult ; Clinical Competence ; Humans ; Inpatients ; Intensive Care Units
مستخلص: Background: Delirium commonly affects hospitalized patients and is associated with increased hospital length of stay, discharge to skilled care, cost, morbidity, and mortality.
Local Problem: At our organization, there was no formal delirium assessment performed by the nursing staff outside of the intensive care unit.
Methods: Assessment of nurses' knowledge about delirium, a nurse-driven delirium screening protocol, and patient education were implemented on an adult inpatient neurology unit. Knowledge change, protocol implementation, and patient-level outcomes were assessed.
Interventions: Staff nurse delirium education and a nurse-driven delirium screening protocol were implemented.
Results: No change in nursing knowledge occurred pre/postintervention. Falls, falls with injury, and restraint and sitter usage decreased. Changes in length of stay varied over the intervention period. The trend to discharge to home increased, while the trend to discharge to skilled nursing care decreased.
Conclusions: Formal delirium screening protocols may add organizational value by positively impacting patient outcomes.
Competing Interests: The authors declare no conflict of interest.
(Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
References: de la Cruz M, Fan J, Yennu S, et al. The frequency of missed delirium in patients referred to palliative care in a comprehensive cancer center. Support Care Cancer. 2015;23(8):2427–2433. doi:10.1007/s00520-015-2610-3.
Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA. 2017;318(12):1161–1174. doi:10.1001/jama.2017.12067.
McCoy TH Jr, Chaukos DC, Snapper LA, Hart KL, Stern TA, Perlis RH. Enhancing delirium case definitions in electronic health records using clinical free text. Psychosomatics. 2017;58(2):113–120. doi:10.1016/j.psym.2016.10.007.
Layne T, Haas SA, Davidson JE, Klopp A. Postoperative delirium prevention in the older adult: an evidence-based process improvement project. Medsurg Nurs. 2015;24(4):256–263.
Rollo E, Callea A, Brunetti V, et al. Delirium in acute stroke: a prospective, cross-sectional, cohort study. Eur J Neurol. 2021;28(5):1590–1600. doi:10.1111/ene.14749.
Meeks JR, Bambhroliya AB, Sheth SA, et al. Long term cognitive impairment associated with delirium in acute neurological injury. Crit Care Expl. 2020;2(6):e0130. doi:10.1097/CCE.0000000000000130.
Marcantonio ER, Kiely DK, Simon SE, et al. Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc. 2005;53(6):963–969. doi:10.1111/j.1532-5415.2005.53305.x.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–922. doi:10.1016/s0140-6736(13)60688-1.
Tieges Z, Quinn T, MacKenzie L, et al. Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis. BMC Geriatr. 2021;21(1):162. doi:10.1186/s12877-021-02095-z.
Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke. 2012;43(3):645–649. doi:10.1161/strokeaha.111.643726.
Miu DK, Yeung JC. Incidence of post-stroke delirium and 1-year outcome. Geriatr Gerontol Int. 2013;13(1):123–129. doi:10.1111/j.1447-0594.2012.00871.x.
McAvay GJ, Van Ness PH, Bogardus ST Jr, et al. Older adults discharged from the hospital with delirium: 1-year outcomes. J Am Geriatr Soc. 2006;54(8):1245–1250. doi:10.1111/j.1532-5415.2006.00815.x.
Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13(4):234–242. doi:10.1046/j.1525-1497.1998.00073.x.
Hare M, Wynaden D, McGowan S, Landsborough I, Speed G. A questionnaire to determine nurses' knowledge of delirium and its risk factors. Contemp Nurse. 2008;29(1):23–31. doi:10.5172/conu.673.29.1.23.
Sinvani L, Kozikowski A, Pekmezaris R, Akerman M, Wolf-Klein G. Delirium: a survey of healthcare professionals' knowledge, beliefs, and practices. J Am Geriatr Soc. 2016;64(12):e297–e303. doi:10.1111/jgs.14544.
Elliott SR. ICU delirium: a survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit. Intensive Crit Care Nurs. 2014;30(6):333–338. doi:10.1016/j.iccn.2014.06.004.
Flagg B, Cox L, McDowell S, Mwose JM, Buelow JM. Nursing identification of delirium. Clin Nurse Spec. 2010;24(5):260–266. doi:10.1097/NUR.0b013e3181ee5f95.
Meako ME, Thompson HJ, Cochrane BB. Orthopaedic nurses' knowledge of delirium in older hospitalized patients. Orthop Nurs. 2011;30(4):241–248. doi:10.1097/NOR.0b013e3182247c2b.
McCrow J, Sullivan KA, Beattie ER. Delirium knowledge and recognition: a randomized controlled trial of a web-based educational intervention for acute care nurses. Nurse Educ Today. 2014;34(6):912–917. doi:10.1016/j.nedt.2013.12.006.
van de Steeg L, IJkema R, Wagner C, Langelaan M. The effect of an e-learning course on nursing staff's knowledge of delirium: a before-and-after study. BMC Med Educ. 2015;15:12. doi:10.1186/s12909-015-0289-2.
Cyrus T, Wenthold R, Hall B, et al. Effectiveness of a delirium prevention initiative on an inpatient neuroscience unit. J Neurosci Nurs. 2021;53(2):75–80. doi:10.1097/jnn.0000000000000580.
Middle B, Miklancie M. Strategies to improve nurse knowledge of delirium: a call to the adult-gerontology clinical nurse specialist. Clin Nurse Spec. 2015;29(4):218–229. doi:10.1097/nur.0000000000000138.
Helfand BKI, D'Aquila ML, Tabloski P, et al. Detecting delirium: a systematic review of identification instruments for non-ICU settings. J Am Geriatr Soc. 2021;69(2):547–555. doi:10.1111/jgs.16879.
De J, Wand AP. Delirium screening: a systematic review of delirium screening tools in hospitalized patients. Gerontologist. 2015;55(6):1079–1099. doi:10.1093/geront/gnv100.
Shenkin SD, Fox C, Godfrey M, et al. Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method. BMC Med. 2019;17(1):138. doi:10.1186/s12916-019-1367-9.
Bellelli G, Morandi A, Davis DH, et al. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing. 2014;43(4):496–502. doi:10.1093/ageing/afu021.
Tieges Z, Maclullich AMJ, Anand A, et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing. 2020;50(3):733–743. doi:10.1093/ageing/afaa224.
Jeong E, Park J, Lee J. Diagnostic test accuracy of the 4AT for delirium detection: a systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17(20):7515. doi:10.3390/ijerph17207515.
Baird L, Spiller JA. A quality improvement approach to cognitive assessment on hospice admission: could we use the 4AT or short CAM? BMJ Open Qual. 2017;6(2):e000153. doi:10.1136/bmjoq-2017-000153.
Brown EG, Josephson SA, Anderson N, Reid M, Lee M, Douglas VC. Evaluation of a multicomponent pathway to address inpatient delirium on a neurosciences ward. BMC Health Serv Res. 2018;18(1):106. doi:10.1186/s12913-018-2906-3.
Rivosecchi RM, Smithburger PL, Svec S, Campbell S, Kane-Gill SL. Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse. 2015;35(1):39–50; quiz 51. doi:10.4037/ccn2015423.
Lee Y, Lee J, Kim J, Jung Y. Non-pharmacological nursing interventions for prevention and treatment of delirium in hospitalized adult patients: systematic review of randomized controlled trials. Int J Environ Res Public Health. 2021;18(16):8853. doi:10.3390/ijerph18168853.
Martinez F, Tobar C, Hill N. Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age Ageing. 2015;44(2):196–204. doi:10.1093/ageing/afu173.
Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693–698. doi:10.1111/jgs.15304.
تواريخ الأحداث: Date Created: 20220429 Date Completed: 20220826 Latest Revision: 20220826
رمز التحديث: 20221213
DOI: 10.1097/NCQ.0000000000000628
PMID: 35486389
قاعدة البيانات: MEDLINE
الوصف
تدمد:1550-5065
DOI:10.1097/NCQ.0000000000000628