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

护士早期发现谵妄叠加痴呆症 (END DSD)

• 批准号: 8046490
• 负责人: DONNA Marie FICK
• 金额: $ 51.38万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8046490
• 关键词: Acute; Address; Aging; Area; Caring; Clinical; Confusion; Control Groups; Data; Delirium; Dementia; Detection; Discipline of Nursing; Documentation; Early Diagnosis; Early treatment; Education; Elderly; Electronic Health Record; Engineering; Feedback; Funding; Future; Healthcare Systems; Hospitalization; Hospitals; Individual; Information Technology; Inpatients; Institutes; Intervention; Length of Stay; Modeling; Neuraxis; Nurses; Nursing Assessment; Nursing Education; Nursing Homes; Nursing Staff; Outcome; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Provider; Publishing; Quality of life; Randomized Controlled Trials; Reporting; Reproducibility; Research; Research Personnel; Severities; Study Section; Testing; Time; Translating; Vulnerable Populations; Work; Workload; base; clinical efficacy; clinical practice; computerized; cost; cost effectiveness; design; functional decline; improved; innovation; mental state; mortality; multi-component intervention; novel strategies; prevent; public health relevance; tool

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.

描述（由申请人提供）：谵妄是一种急性、可逆的精神状态变化，超过 40% 的痴呆症患者会出现这种情况。痴呆症 (DSD) 叠加谵妄会导致死亡率增加、费用增加、疗养院安置、早期再住院和功能下降。痴呆症患者的谵妄似乎会大大恶化痴呆症患者的预后——他们已经患有功能衰退。本研究的目的是改善痴呆症患者谵妄的护理检测和管理，并减少谵妄的持续时间和患者并发症。为了实现这些目标，将测试一种名为“早期护士检测谵妄叠加痴呆症”(END DSD) 的多成分干预策略。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)，涉及 3 家医院、总共 6 个住院病房和 390 名住院痴呆症患者。 END DSD 将包括 1) 有关 DSD 的护理教育，2) 通过标准化谵妄评估和管理屏幕通过电子健康记录 (EHR) 提供计算机化决策支持，3) 每个干预单元指定一名单位冠军，用于说服其他护士实施创新，以及 4) 每周向护理人员提供反馈，以进一步促进谵妄的评估和管理。我们正在测试以下具体目标： A.1 具体目标 1：确定干预措施“END DSD”是否改善了护士对 DSD 的发现和管理。 A.2 具体目标 2：确定“END DSD”干预对患者临床结果的影响，包括谵妄持续时间和精神活性药物的使用率。这项研究重点关注一个成本高昂且普遍存在的问题，并采用了一种新颖的方法，通过 EHR，该方法显然可以在各个护理环境中复制。 END-DSD 有潜力通过以下方式显着提高生活质量并降低护理成本： 改进 DSD 的检测；增加 DSD 非药物管理的使用；缩短谵妄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协作努力结合在一起，以影响住院老年人中未得到解决的 DSD 问题。 公共卫生相关性：谵妄（急性精神错乱）在痴呆症患者中很常见，而且费用高昂，导致住院时间更长、并发症更多、功能衰退更严重。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，以改善谵妄的检测和管理。最终，研究结果将为改善这一弱势群体的紧急护理提供指导。