谵妄是一种严重而常见的疾病,对住院的老年人会导致严重的不利健康结果。它发生在30%-55%的髋部骨折患者中,是骨科手术老年人最常见的术后并发症之一。多成分、非药物干预可将谵妄发生率降低高达30%,但作为常规护理的一部分实施往往具有挑战性。我们发现了一个缺口,在交付非药物干预骨科单位。该项目旨在通过鼓励工作人员对高危老年人使用多成分循证谵妄预防策略,在骨科病房实施床边标识,以减少谵妄的发生。质量改进方法被用于整合和优化骨科病房床边“谵妄预防”标志的使用。该标识在4个目标房间实施,标识完成率从47%提高到83%(95%置信区间71.7%至94.9%;P <0.001)。这一迹象对谵妄患病率没有显著影响。基线期平均混淆评估法(CAM)+比率为8%,干预期绝对增加至11.4% (95% CI 7.2%至15.8%;p = 0.31)。 There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.
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