An evolving approach to delirium: A mixed-methods process evaluation of a hospital-wide delirium program in New Zealand
An evolving approach to delirium: A mixed-methods process evaluation of a hospital-wide delirium program in New Zealand
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DOI：
10.1111/ajag.12406
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发表时间：
2017-06-01
影响因子：
1.6
通讯作者：
Allen-Narker, Rosalind A. C.
中科院分区：
文献类型：
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作者：
Alhaidari, Abdullah A. O.;Allen-Narker, Rosalind A. C.
目的进行过程评估，以评估并可能改进全院谵妄计划的设计和实施。方法采用混合方法序贯解释性设计；我们对 100 名老年 (75 岁以上) 住院患者进行了回顾性图表审查，以衡量护士、医生和编码员对关键计划流程的遵守情况，随后进行访谈以确定实施的潜在障碍。结果 49% 的患者出现谵妄。图表审查显示，对谵妄风险评估（66%）、简短混乱评估方法（入院时 50%，入院期间 58%）、临床记录中的谵妄记录（80%）和出院信函（38%）以及谵妄编码（49%）的遵守情况不佳。所确定的实施的主要障碍是未能招募非护理人员、目标和指示不明确、使用 Short-CAM 的困难、优先事项相互竞争的时间限制以及缺乏结果预期。结论根据这些发现，需要制定一个新的谵妄计划。
ObjectiveA process evaluation was carried out to assess and potentially improve the design and implementation of a hospital-wide delirium program.MethodsA mixed-methods sequential-explanatory design was used; retrospective chart reviews for 100 older (75+) medical inpatients were conducted to measure nurses', doctors' and coders' adherence to key program processes following which interviews were conducted to identify potential barriers to implementation.ResultsDelirium occurred in 49% of patients. Chart reviews revealed suboptimal adherence to the delirium risk assessment (66%), the Short Confusion Assessment Method (50% on admission, 58% during admission), documentation of delirium in clinical records (80%) and discharge letters (38%) and coding for delirium (49%). The major barriers to implementation identified were failure to recruit non-nursing staff, unclear goals and instructions, difficulties using the Short-CAM, time constraints with competing priorities and lack of outcome expectancy.ConclusionA new delirium program was needed based on these findings.