提升加護病房護理人員預防病人譫妄之照護執行率

Promoting Delirium Prevention among Patients in an Intensive Care Unit

10.6142/VGHN.202009_37(3).0003

劉怡妙(Yi-Miao Liou)；張凱琳(Kai-Lin Chang)；黄惠美(Hui-Mei Huang)；蔡寶純(Bao-Chuem Tsay)；陳雅惠(Ya-Huei Chen)

加護病房 ； 譫妄 ； PADIS ； intensive care unit ； delirium ； PADIS

榮總護理

37卷3期（2020 / 09 / 01）

244 - 251

繁體中文

當加護病房病人發生譫妄症狀時，容易意識混亂、情緒不穩定、發生病安事件、延長住院天數。本專案目的在提升加護病房預防病人譫妄之照護執行率，依疼痛、躁動、譫妄、制動、睡眠紊亂（pain, agitation, delirium, immobility, sleep disruption; PADIS）指引制定「加護病房病人譫妄查核表」，經資料分析原因為加護病房混亂評估量表使用率低、移位椅使用率低、病人睡眠易被干擾、缺乏定向感刺激。解決辦法包括製作加護病房混亂評估量表評估圖卡、拍攝使用移位椅教學影片、為病人用上耳塞、眼罩、設計「報時小曲」廣播內容。執行措施後譫妄照護執行率由67.3%提升至97.4%，加護病房病人譫妄發生率由41.2%降至27.5%，期望本專案做為臨床照護之參考。

When a patient in an intensive care unit (ICU) develops delirium, their safety is compromised and their hospital stay extended. Such events increase the work pressure of medical personnel. This study aimed to improve the delirium care for such patients. Between October and December 2017, our ICU established a special work force. The findings of this study were as follows: (1) Use of the Confusion Assessment Scale (CAM)-ICU was low; (2) familiarity with the operation of the transfer commode chair was lacking; (3) the patients had sleep disturbances; and (4) the patients had disorientation. The problematic issues were resolved through various measures. Using advocacy projects, education, and training, we produced CAM-ICU evaluation chart cards and formulated specific protocols for patient care regarding sitting out of bed, using eye masks and earplugs, and timely musical reminders. Afterwards, the total prevention rate of delirium care in patients was 97.4% compared with 67.3% before the intervention. The delirium incidence in patients in the ICU was reduced from 41.2% to 27.5%. We expect that this project will serve as a reference in similar clinical settings.

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