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

描述（由申请人提供）：谵妄是一种急性、可逆的精神状态变化，发生在40%以上的痴呆患者中。谵妄叠加痴呆（DSD）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。痴呆症患者的谵妄似乎大大恶化了痴呆症患者的预后-他们已经承受着功能衰退的负担。本研究的目的是改善痴呆患者谵妄的护理检测和管理，减少谵妄的持续时间和患者并发症。为了实现这些目标，将测试一种多组分干预策略，称为痴呆叠加谵妄的早期护士检测（END DSD）。我们提出了一个配对的集群随机对照试验（C-RCT）的三家医院，共6个住院单位和390名住院的痴呆症患者，以实现这些目标。END DSD将包括1）关于DSD的护理教育，2）通过电子健康记录（EHR）通过标准化谵妄评估和管理屏幕提供计算机化决策支持，3）每个干预单元的指定单元冠军将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“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“END DSD”干预对患者临床结局的影响，包括谵妄持续时间和精神活性药物的使用率。这项研究的重点是一个昂贵的和普遍的问题，并利用一种新的方法，通过电子病历将显然是可复制的整个设置的护理。END-DSD有可能通过以下方式显著改善生活质量并降低护理成本：改善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;减少使用不适当的药物，从而减轻DSD的并发症。该项目建立在研究人员十多年的资助研究和临床实践的基础上，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尚未解决的DSD问题。 公共卫生相关性：谵妄（急性意识模糊）在痴呆患者中很常见，费用高昂，导致住院时间更长，并发症更多，功能下降更严重。这项研究测试了使用电子健康记录，教育和定期反馈给护士，以改善谵妄的检测和管理。最终，研究结果将指导如何改善对这一弱势群体的急性护理。

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.