提升加護病房護理師譫妄認知與評估

Improving Critical Care Nurse’s Recognition and Assessment of Delirium for ICU Patients

重症病人譫妄發生率高達30%。早期偵測，可有效預防譫妄發生，而本單位護理師對於譫妄認知與評估正確率皆低於60%。經確認原因為缺乏在職訓練、沒有合適評估工具、譫妄護理評估系統以及評估流程不熟悉等，引發改善動機。提升護理師譫妄認知及評估正確率。採多元且資訊化的策略如舉辦重症譫妄面授課程、建置重症譫妄線上課程，以利後續翻轉教學、設置臨床相關案例討論平台、翻譯並推廣合適評估工具、設置電子評估表單於加護病房資訊系統、規劃譫妄評估流程提示區，以及建立譫妄評估流程稽核報表等提升認知與評估能力。譫妄照護認知與評估正確率提升，皆大於90%。多元策略資訊化的導入，助益於增進臨床護理師對於重症譫妄照護能力。

Previous studies have indicated that the incidence of delirium in critically ill patients is higher than 30% and early detection is crucial for effective management. However, accuracy rate of nursing assessment of delirium was only 60%, neither have enough concept about delirium, nor have qualified evaluation ability in providing immediate care of those patients. The related factors were disclosed in our investigation, including few relevant training, lack of appropriate assessment tools, insufficient nursing evaluation system and unfamiliar with the disease process. We proposed a project aiming at improving the accuracy rate of both delirium recognition and assessment by our nurse. We adopted diversified and informatized strategies, such as organizing face-to-face courses on intensive care followed by online learning, setting up platforms for clinical case discussion, translating and promoting appropriate evaluation tools, etc. The relevant electronic documents including the workflow were integrated into the intensive care unit (ICU) information system to call attention to early detection as well as facilitate assessment and audit. The accuracy rate of recognition and nursing care on delirium increased to over 90%. The use of multi-strategy and information technology can help to improve the ability of clinical nurses for critical delirium patients. This project can provide a reference for the diagnosis of complex critical care assessment.