Implementing Clinical Practice Guidelines for Screening and Detection of Delirium in a 21-Hospital System in Northern California Real Challenges in Performance Improvement
Implementing Clinical Practice Guidelines for Screening and Detection of Delirium in a 21-Hospital System in Northern California Real Challenges in Performance Improvement
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DOI：
10.1097/nur.0000000000000098
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发表时间：
2015-01-01
影响因子：
1.2
通讯作者：
Cheng, Eugene
中科院分区：
文献类型：
--
作者：
Adams, Carmen L.;Scruth, Elizabeth Ann;Cheng, Eugene
目的：本文的目的是描述大型医疗机构针对不同成人重症监护病房 (ICU) 人群的质量改进流程，以便及早发现谵妄。背景：谵妄通常被认为是 ICU 中常见的不可预防的问题。早期发现谵妄的流程允许重症监护团队评估患者并进行干预，以改善或逆转谵妄。 描述：首先开发一个业务案例，然后使用绩效改进方法结合质量改进方法和谵妄/镇静工作组的监督，制定实施计划。重症监护临床护士专家接受了教育；床边护士使用意识模糊评估法对 ICU 患者每天两次进行谵妄筛查。每个 ICU 的临床护士专家在推动变革过程并支持床边护士和医生讨论预防、筛查和治疗谵妄方面发挥了重要作用。结果：全系统流程实施在 2011 年一年内完成。2012 年，所有医疗中心都制定了一项计划，以减少苯二氮卓类药物的使用，并改善多学科团队在日常巡诊中关于谵妄治疗和预防的沟通。绩效改进的过程是持续进行的，需要不断地重新评估和反馈，以确保可持续性。结论/实践启示：涉及 21 个医疗中心的绩效改进是组织的一项大规模工作。它需要采用系统方法，让关键利益相关者和高级执业护士作为主题专家参与整个实施的所有阶段。评估患者的床边临床医生必须感受到整个过程中的支持和重视。需要承认并解决所有护理提供者面临的挑战。
Purpose:The purpose of this article was to describe a quality improvement process on a diverse adult intensive care unit (ICU) population for a large healthcare organization for early detection of delirium.Background:Delirium is often considered a common unpreventable problem in the ICU. A process for early detection of delirium allows the critical care team to evaluate the patient and intervene to improve or reverse the delirium.Description:A business case was first developed, and then using performance improvement methodology combined with quality improvement methods and oversight from a Delirium/Sedation Workgroup, an implementation plan was developed. Intensive care clinical nurse specialists were educated; patients in the ICU were screened for delirium twice daily by bedside nurses using the Confusion Assessment Method. The clinical nurse specialist in each ICU was instrumental for driving the process of change and supporting the bedside nurse and physicians to discuss preventing, screening, and treating delirium.Outcome:System-wide process implementation was completed in 1 year, 2011. In 2012, all medical centers had a program in place to decrease the use of benzodiazepines and improve communication in the multidisciplinary teams during daily rounds about the treatment and prevention of delirium. The process of performance improvement is ongoing with continual reassessment and feedback required to ensure sustainability.Conclusions/Implications for Practice:Performance improvement involving 21 medical centers is a large-scale undertaking by an organization. It requires a systematic approach with key stakeholders and advanced practice nurses as subject matter experts involved throughout all phases of the implementation. Bedside clinicians assessing the patient must feel supported and valued members of the process. Challenges of all care providers need to be acknowledged and addressed.