建置住院高齡病人譫妄實證照護指引

背景：住院高齡病人健康問題複雜，其中譫妄為最常見之認知障礙，與住院天數、死亡率及機構化有關。然而，國內目前缺乏高齡譫妄相關照護指引，可供護理人員依循。目的：以實證為基礎發展住院高齡病人譫妄照護指引。方法：於南部某醫學中心成立跨領域指引發展小組，透過背景問題建構、系統性文獻回顧與評讀，整合並初擬照護指引。指引初稿經由修正型德菲法專家共識決策後，於高齡照護病房評值臨床通用性，以完成本土譫妄照護指引。結果：本譫妄照護指引包含三個相關議題及35項建議。方法學與臨床專家對於譫妄指引評價為建議使用。臨床適用性評值部分，護理人員認為大部份的指引建議在臨床上是可行且容易做到的，唯「提供治療性環境」、「促進睡眠措施」與「必要時尋求藥物處置」執行較困難。結論／實務應用：本研究發展之「住院高齡病人譫妄實證照護指引」，整合最佳實證證據與專家建議，未來可落實於臨床照護，以維護住院高齡病人照護品質。

關鍵字

住院高齡病人；譫妄；照護指引

並列摘要

Background: The health problems of hospitalized older patients are complicated, with delirium a common neurocognitive disorder in this population. Delirium has been correlated with the longer periods of hospitalization, higher mortality, and higher rates of institutionalization. However, clinical practice guidelines for delirium management in hospitalized older patients are lacking. Purpose: The purpose of this study was to develop evidence-based practice guidelines for delirium management in hospitalized older patients. Methods: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members reviewed current delirium practice guidelines. A revised set of practice guidelines was developed by constructing foreground questions on key issues and by systematically searching, appraising, and synthesizing the relevant evidence. After a new draft of the guidelines was established, the Delphi method was used to reach a consensus among experts. Finally, the developed guideline document was applied in a geriatric ward of a medical center in order to evaluate applicability. Results: The developed delirium guidelines address 3 issues with 35 recommendations. The panel of clinical and methodological experts recommended that these delirium guidelines be applied in practice. Most nurses in the targeted geriatric ward indicated that the guidelines were feasible and easy to implement. However, several of the procedures were identified as difficult to implement, including ＂provide a therapeutic environment＂, ＂promote good sleep patterns and sleep hygiene＂, and ＂consider psychotropic medication as a last resort for agitation＂. Conclusion/Implications for Practice: The evidence-based delirium management guidelines for hospitalized older patients that were developed in this study integrates the recommendations from the best available evidence and earned a high consensus among clinical experts. Thus, these guidelines are recommended for clinical application.

並列關鍵字

hospitalized older patients ； delirium ； pclinical practice guidelines

參考文獻

王智瑩、陳人豪（2017）．長照體系內譫妄症與急性問題行為之評估與處置．長期照護雜誌，21（2），93–104。[Wang, C. Y., & Chen, J. H. (2017). Assessment and management of delirium and acute problematic behavior in the long-term care setting. The Journal of Long-Term Care, 21(2), 93–104.] https://doi.org/10.6317/LTC.21.93

宋惠娟、張淑敏（2006）．臨床決策：實證實務的步驟．志為護理—慈濟護理雜誌，5（3），73–80。[Sung, H. C., & Chang, S. M. (2006). Clinical decision-making: The steps of evidence-based practice. Tzu Chi Nursing Journal, 5(3), 73–80.] https://doi.org/10.6974/TCNJ.200606.0073

楊鎮嘉、高玉娟（2017）．譫妄症臨床診治．長期照護雜誌，21（2），81–92。[Yang, J. J., & Kao, Y. C. (2017). Clinical management of delirium. The Journal of Long-Term Care, 21(2), 81–92.] https://doi.org/10.6317/LTC.21.81

Ahmed, S., Leurent, B., & Sampson, E. L. (2014). Risk factors for incident delirium among older people in acute hospital medical units: A systematic review and meta-analysis. Age and Ageing, 43(3), 326–333. https://doi.org/10.1093/ageing/afu022

American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. (2015). American geriatrics society abstracted clinical practice guideline for postoperative delirium in older adults. Journal of the American Geriatrics Society, 63(1), 142–150. https://doi.org/10.1111/jgs.13281

被引用紀錄

羅心怡、陳雅芳、陳怡君、鄭青青（2022）。運用多元化策略降低外科高齡病人譫妄發生率。護理雜誌，69(6)，65-74。https://doi.org/10.6224/JN.202212_69(6).09

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建置住院高齡病人譫妄實證照護指引

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