建置住院高齡病人譫妄實證照護指引

Evidence-Based Clinical Practice Guidelines: Delirium Management in Hospitalized Older Patients

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。 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.