提升心臟外科加護病房護理人員譫妄評估執行率

Improving the Implementation Rate for Delirium Assessment Among Nurses In Cardiovascular Surgical Intensive Care Unit

心臟術後病人的高譫妄盛行率會造成高罹病率、延長住院日數；而高比率之譫妄誤診與譫妄知識缺失、缺乏快速評估表有關。本單位護理人員譫妄知識正確率只有63.8％，譫妄評估執行率僅13％，現況分析後確立問題為譫妄知識不足，評估技巧不純熟、缺乏譫妄評估流程以及未建立病房常規。專案目的希望提升護理人員對譫妄知識正確率及評估執行率，解決方案包括制定心臟術後加護單位譫妄病人評估處置流程、建立譫妄評估病房常規、舉辦在職教育課程及床邊教學指導。結果提升了護理人員對譫妄知識正確率由63.8％至86.4％，譫妄評估執行率由13％至85％。結論希望透過本專案建立之譫妄評估處置流程，提供其它加護病房使用，維護病人安全並提升整體醫療照護品質。

Delirium prevalence is high after cardiovascular surgery in intensive care unit (CVSICU), which causes high morbidity and long length of stay. It all relates to the fact that nurses lack of knowledge about delirium, resulting in delayed response and use of ineffective equipment to evaluate. The rate of correct knowledge about delirium was 63.8%, and implementation rate of delirium assessment was only 13% in the unit. The analysis identified several problems, including lack of knowledge about delirium, lack of assessment skills, lack of evaluation and management procedure, and absence of established routines at the ward. The purpose of the project was to improve the knowledge about delirium and increase the implementation of delirium assessment among nurses. Several improvement measures were in place, including developing the evaluation and management protocol for delirium in CVSICU, establishing a standard evaluation routine in the , conducting bed-side teaching, and creating on-job training courses. The result showed that the knowledge about delirium increased from 63.8% to 86.4%, the implementation rate of delirium assessment increased from 13% to 85%. The outcome of the project demonstrated a good example of building standard evaluation procedures for delirium with the hope to decrease the incidence of delirium, enhance the safety of patients, and increase the quality of care.