提升加護病房護理人員預防病人譫妄之照護執行率

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。

關鍵字

加護病房；譫妄； PADIS

並列摘要

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.

並列關鍵字

intensive care unit ； delirium ； PADIS

參考文獻

楊鎮嘉、高玉娟（2017）‧譫妄症臨床診治‧長期照護雜誌，21（2），81-92。

陳季涵、周幸生（2015）‧重症病人譫妄的群組照護‧領導護理，16（1），2-10。

賴玟苑、王韵宜、田秀娟、蘇美蘭、林淑媛(2011)‧譫妄實證照護之應用‧護理雜誌，58(2)，75-80。

武香君、周汎澔（2008）‧音樂治療緩解呼吸器使用患者焦慮之心理及生理反應成效‧護理雜誌，55（5），35-44。

Inouye, S. K. Westendorp, R. GJ., Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.

國際替代計量

提升加護病房護理人員預防病人譫妄之照護執行率

全文下載

主題瀏覽