Implementing delirium screening in the ICU: secrets to success.
Implementing delirium screening in the ICU: secrets to success.
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在ICU中实施ir妄筛查：成功的秘诀。
DOI：
10.1097/ccm.0b013e31829a6f1e
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发表时间：
2013-09
影响因子：
8.8
通讯作者：
Ely EW
中科院分区：
文献类型：
--
作者：
Brummel NE;Vasilevskis EE;Han JH;Boehm L;Pun BT;Ely EW
回顾成人和儿科ICU中可用的精神错乱筛查工具，回顾循证精神错乱筛查的实施，并讨论在ICU中精神错乱筛查过程中遇到的常见陷阱。对精神分裂症筛查文献和专家意见进行综述。在过去的十年里，专门为危重成人和儿童设计的工具已经开发和验证。精神错乱筛查已在许多ICU环境中有效实施。有效实施的关键包括解决常规筛查的障碍、多方面的培训，如讲座、以病例为基础的情景、一对一的教学以及通过讨论患者在床边查房期间的精神错乱状况和通过文件系统实时反馈精神错乱筛查和跨学科交流。如果出现精神错乱，临床医生应该寻找可逆或可治疗的原因，因为它通常是多因素的。实施有效的精神错乱筛查是可行的，但需要注意实施方法，包括改变目前的ICU文化，认为精神错乱是不可避免的或危重疾病的正常部分，改变为未来的文化，将精神错乱视为一种危险的综合征，预示着不良的临床结果，并可能根据个别患者的情况而改变。
To review delirium screening tools available for use in the adult and pediatric ICU, review evidence-based delirium screening implementation and to discuss common pitfalls encountered during delirium screening in the ICU. Review of delirium screening literature and expert opinion. Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICUs settings. Keys to effective implementation include addressing barriers to routine screening, multi-faceted training such as lectures, case-based scenarios, one-on-one teaching and real-time feedback of delirium screening and interdisciplinary communication through discussion of a patient’s delirium status during bedside rounds and through documentation systems. If delirium is present clinicians should search for reversible or treatable causes since it is often multifactorial. Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances.