Early Nurse Detection of Delirium Superimposed on Dementia (END DSD)

描述(由申请人提供)：精神错乱是一种急性的、可逆的精神状态变化，发生在超过40%的痴呆症患者中。痴呆症叠加精神错乱(DSD)会导致死亡率增加、费用增加、养老院安置、早期再住院和功能下降。痴呆症患者的精神错乱似乎大大恶化了痴呆症患者的结果-他们已经背负着功能衰退的负担。本研究的目的是改善痴呆症患者的护理、发现和管理，减少痴呆症的病程和患者的并发症。为了实现这些目标，将测试一种多成分干预策略，称为早期护士检测痴呆症叠加妄想症(End DSD)。为了实现这些目标，我们提出了一项配对整群随机对照试验(C-RCT)，包括三家医院，总共六个住院单元和390名住院的痴呆症患者。DSD将包括1)有关DSD的护理教育，2)通过电子健康记录(EHR)进行标准化的精神错乱评估和管理屏幕的计算机决策支持，3)每个干预单位的确定的单位冠军，他将被用来说服其他护士实施创新，以及4)每周向护理人员反馈，以进一步促进对精神错乱的评估和管理。我们正在测试以下具体目标：A.1具体目标1：确定干预“结束DSD”是否改善了护士对DSD的检测和管理。A.2具体目标2：确定“结束精神障碍”干预对患者临床结果的影响，包括精神错乱的持续时间和精神活性药物的使用率。这项研究聚焦于一个昂贵而普遍的问题，并利用了一种新的方法，通过EHR显然可以在不同的护理环境中复制。END-DSD有可能通过以下方式显著提高生活质量和降低护理成本：改进DSD的检测；增加对DSD的非药物治疗；缩短精神错乱的持续时间和住院时间；减少不适当药物的使用，从而减轻DSD的并发症。该项目建立在研究人员十多年来资助的研究和临床实践的基础上，并以创新的方式将他们独特的合作努力结合在一起，以影响住院老年人中未得到充分解决的DSD问题。 与公共卫生相关：痴呆症(急性精神错乱)在痴呆症患者中很常见，代价也很高，导致更长的住院时间、更多的并发症和更大的功能衰退。这项研究测试了电子健康记录、教育和定期向护士反馈的使用情况，以改进对精神错乱的检测和管理。最终，这些发现将指导改善对这一弱势群体的急性护理的方法。

DESCRIPTION (provided by applicant): Delirium is an acute, reversible change in mental status that occurs in over 40% of persons with dementia. Delirium superimposed on dementia (DSD) leads to increased mortality, increased costs, nursing home placement, early re-hospitalization, and functional decline. Delirium in persons with dementia appears to substantially worsen outcomes in persons with dementia----who are already burdened with functional decline. The purpose of this proposed study is to improve nursing detection and management of delirium in persons with dementia and decrease the duration and patient complications of delirium. To achieve these objectives, a multi- component intervention strategy called, Early Nurse Detection of Delirium Superimposed on Dementia (END DSD) will be tested. We propose a paired cluster randomized controlled trial (C-RCT) of three hospitals with a total of six inpatient units and 390 hospitalized persons with dementia to achieve these objectives. END DSD will consist of 1) Nursing education regarding DSD, 2) Computerized decision support through standardized delirium assessment and management screens via the electronic health record (EHR), 3) an identified unit champion on each intervention unit who will be utilized to persuade others nurses to implement the innovation, and 4) Weekly feedback to the nursing staff to further facilitate assessment and management of delirium. We are testing the following specific aims: A.1 Specific Aim 1: To determine whether the intervention "END DSD" improves nurse detection and management of DSD. A.2 Specific Aim 2: To determine the effect of the "END DSD" intervention on patient clinical outcomes, including duration of delirium and rate of psychoactive medications. This study focuses on a costly and prevalent problem, and utilizes a novel approach that via the EHR will clearly be replicable across settings of care. END-DSD has the potential to significantly improve quality of life and decrease costs of care by: improving the detection of DSD; increasing the use of non-pharmacological management of DSD; shortening the duration of delirium and hospital length of stay; and decreasing the use of inappropriate medications, thus mitigating the complications of DSD. This project builds on over a decade of funded research and clinical practice by the investigators, and brings their unique and collaborative efforts together in an innovative manner to impact the under addressed problem of DSD in hospitalized older adults. PUBLIC HEALTH RELEVANCE: Delirium (acute confusion) is common and costly in persons with dementia, resulting in longer hospital stays, more complications, and greater functional decline. This research tests the use of the electronic health record, education, and regular feedback to nurses to improve detection and management of delirium. Ultimately, findings will direct ways to improve acute care of this vulnerable population.