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

描述（由申请人提供）：谵妄是一种急性的、可逆的精神状态变化，发生在超过40%的痴呆症患者身上。谵妄叠加痴呆（DSD）导致死亡率增加，费用增加，养老院安置，早期再次住院和功能下降。痴呆患者的谵妄似乎大大恶化了已经有功能衰退负担的痴呆患者----的预后。本研究旨在改善痴呆患者谵妄的护理发现和管理，减少谵妄的持续时间和患者并发症。为了实现这些目标，一个多成分的干预策略，称为早期护士检测谵妄叠加痴呆（END DSD）将进行测试。为了实现这些目标，我们提出了一项配对集群随机对照试验（C-RCT），包括三家医院共六个住院病房和390名住院的痴呆症患者。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进行计算机化决策支持，3)在每个干预单元中确定一名单位倡导者，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“END DSD”是否能提高护士对DSD的发现和管理。A.2具体目标2：确定“END DSD”干预对患者临床结局的影响，包括谵妄持续时间和精神活性药物使用率。本研究的重点是一个昂贵和普遍的问题，并利用一种新颖的方法，通过电子病历将显然是可复制的护理设置。END-DSD有潜力通过以下方式显著改善生活质量和降低护理成本：改善DSD的检测；增加对DSD的非药物管理；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的资助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，以影响住院老年人的DSD问题。

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.