降低成人加護病房病人譫妄之發生率

Reducing the Incidence of Delirium in Patients in Adult Intensive Care Units

10.6142/VGHN.202103_38(1).0006

鍾幸枝(Hsing-Chi Chung)；陳柑伴(Kang-Pan Chen)

加護病房 ； 譫妄 ； 發生率 ； adult intensive care unit ； delirium ； incidence

榮總護理

38卷1期（2021 / 03 / 01）

54 - 62

繁體中文

譫妄是加護病房病人常見的問題，它會延長住院天數及醫療支出成本，本單位2017年7月至11月病人譫妄發生率23.7％，護理師評估譫妄正確率僅67.8％，因此引發專案動機。歸納問題導因為病人對環境有孤立感、護理師對譫妄評估認知不足、早期復健執行不良。專案目的在降低病人譫妄發生率及提升護理師評估譫妄的正確率。對策：規劃溫馨病室環境、修訂會客制度、舉辦譫妄在職教育、建立稽核護理師評估CAM-ICU制度、建立譫妄智慧評估系統及處置作業流程、設計童玩及早期目標導向復健智慧流程。成效：病人譫妄發生率下降至7.3％，護理師評估譫妄正確率提升至97.0％。本專案創新兩項智慧化作業流程，不僅達到專案目的，更提升照護品質，值得廣泛推廣與應用。

Delirium is a common problem for patients in the intensive care unit (ICU). It increases the length of hospital stays and medical expenses. From July to November 2017, the incidence of delirium in our unit was 23.7%. Nursing staff had a delirium assessment accuracy of only 67.8%, which motivated this study. Problems that contribute to this low accuracy include patients' sense of isolation from the environment, nursing staff's insufficient knowledge on how to assess delirium, and poor implementation of early rehabilitation. The purpose of this study was to reduce the incidence of delirium in patients and increase the accuracy of nursing staff in assessing delirium. The key interventions of this study included formulating plans to establish a warm ICU environment, revising family visit protocol, filming educational videos, providing on-the-job education on delirium, establishing a smart delirium assessment system, and designing toy rehabilitation and early goal-oriented rehabilitation smart systems. The incidence of delirium in patients was reduced to 7.3%, and the accuracy of nurses' assessment of delirium increased to 97%. By innovating two smart health care systems, this project fulfills its key aims as well as improves the quality of care, thus demonstrating that it is worthy of widespread promotion and application.

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