提升加護病房護理師譫妄評估能力

Improving the Ability of Nurses in Intensive Care Unit to Assess Delirium

加護病房病人發生譫妄比率高，更是非計畫性氣管內管滑脫常見原因。本專案動機為單位2018年非計畫性氣管內管滑脫中，自拔管佔83.3%，60%於病人譫妄時發生。其中1例導致非預期性急救，因此護理師譫妄評估能力十分重要。經現況調查發現，護理師對譫妄認知不足、未建構譫妄篩檢評估工具、譫妄篩檢評估未列入規範和單位缺乏譫妄相關在職教育。藉由改善措施提升護理師譫妄評估能力，透過舉辦譫妄認知及篩檢評估課程、導入篩檢評估工具（ICDSC）並列入單位常規，使護理師譫妄認知正確率由74.5%提升86.3%，譫妄篩檢評估執行率由34.1%提升98.7%，達成專案目標。藉此專案成效亦已推行到其他加護病房，提供臨床照護參考。

The high frequency of delirium in ICU patients is a common reason of unplanned endotracheal extubation. Self-extubation accounted for 83.3% of unplanned endotracheal extubation in ICU in 2018, of which 60% occurred during unidentified delirium and shortage of early prevention measures; one case even led to unexpected cardiac arrest that needed resuscitation. Therefore, the project aims to improve the ability of ICU nurses to assess delirium through effective strategy. Through the survey, researchers found that ICU nurses’ lack of cognition in delirium, delirium screening tool, regulation on mandated delirium screening, and on-job-education. Based on these factors, delirium screening and assessment lectures, construction of ICDSC are both included into the routine of assessment in ICU. Results showed the rate of nurses’ correct cognition to delirium increases from 74.5% to 86.3 %. The rate of ICDSC assessment completeness raised from 34.1% to 98.7%. Both rates have fulfilled the goal of this project. It is expected that the effectiveness of the project can be utilized in all ICUs in hospital, and be a reference for clinical care.