改善医院谵妄筛查和记录。

IF 2.5 4区 医学 Q1 NURSING
American Journal of Nursing Pub Date : 2025-07-01 Epub Date: 2025-06-26 DOI:10.1097/AJN.0000000000000103
Stephanie Chambers, Renu Bhargavi Boyapati, Rachel Gagliasso, Linda Griebenow, Shant Ayanian, Christopher Kohler, Sandeep Pagali
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引用次数: 0

摘要

背景:适当的谵妄筛查和记录对于住院患者确保积极的患者预后和患者安全非常重要。明尼苏达州罗彻斯特市梅奥诊所的初步流程审查发现,谵妄筛查和文件要求的依从性较低(25.9%)。目的:本质量改进(QI)项目的目的是确定谵妄筛查和记录方面的差距,确定这些差距的可能原因,并设计干预措施,以帮助改善一年内谵妄筛查和记录的完成情况,同时不影响其他所需的护理评估。该项目的目标是将筛选文件的比率提高至少50%。方法:在梅奥诊所的初步流程审查确定谵妄筛查和文件要求的低依从性后,召集了一个多学科工作组,并在2022年5月至2023年4月(研究期间)实施了六西格玛方法的QI项目。对电子健康记录(EHRs)的审查以及对护士和个人护理助理的非正式调查(通过访谈和跟踪加强)促进了鱼骨分析和影响努力网格的创建,显示了可能的干预措施的相对难度和影响。开发了EHR的自动数据监控仪表板,并对EHR中的简要混淆评估方法(bCAM)文档进行了重组和引入(第一次干预)。修订了护士教育模块,使其在各个实践领域保持一致,并创建了最佳实践咨询(BPA),以架起护士(rn)和临床医生(医生、np和医师助理)之间沟通的桥梁。谵妄筛查被添加到2023年2月所需轮班文件的提醒列表中(第二次干预)。选择了一项平衡措施,即压力伤害风险,作为其他所需护理评估的代理,以显示其他工作人员业绩的任何无意下降。结果:在2022年6月1日引入bCAM重新设计后,到6月30日,谵妄筛查文件减少到17.4%,但到7月31日增加到19.4%。在7月1日实施RN教育模块后,谵妄筛查文件进一步增加,到8月达到20.7%,但到2023年1月再次下降至13.7%。在2023年2月将谵妄筛查纳入所需轮班文件提醒清单后,谵妄筛查文件的发生率显著增加,从2022年5月的25.9%基线率上升到2023年3月的42.8% (P < 0.001)和2023年4月的47.7% (P < 0.001)。BPA还与临床医生在电子病历中诊断谵妄的比例增加了47%有关。在整个研究期间,压力损伤风险评估率保持不变,只有轻微波动。结论:在这个QI项目中,在轮班记录中加入谵妄筛查与筛查记录增加50%以上相关,表明改善了护士-临床沟通。BPA的引入也与临床医生在电子病历中谵妄诊断的增加有关。实施这些干预措施可能会改善患者的预后和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improving Hospital Delirium Screening and Documentation.

Background: Appropriate delirium screening and documentation are important for hospitalized patients to ensure positive patient outcomes and patient safety. A preliminary process review at Mayo Clinic in Rochester, Minnesota, identified low adherence (25.9%) to delirium screening and documentation requirements.

Purpose: The aim of this quality improvement (QI) project was to identify gaps in delirium screening and documentation, determine possible causes of these gaps, and design interventions to help improve the completion of required delirium screening and documentation over one year without adversely affecting other required nursing assessments. The target of the project was an improvement in the rate of screening documentation of at least 50%.

Methods: After Mayo Clinic's preliminary process review identified low adherence to delirium screening and documentation requirements, a multidisciplinary workgroup was convened, and a QI project following Six Sigma methods was implemented between May 2022 and April 2023 (the study period). Review of electronic health records (EHRs) and an informal survey of nurses and personal care assistants (enhanced by interviews and shadowing) facilitated fishbone analysis and creation of an impact-effort grid showing the relative difficulty and impact of possible interventions. An automated data-monitoring dashboard for the EHR was developed, and the Brief Confusion Assessment Method (bCAM) documentation in the EHR was restructured and introduced (first intervention). Nurse educational modules were amended to be consistent across practice areas, and a best-practice advisory (BPA) was created to bridge communication between nurses (RNs) and clinicians (physicians, NPs, and physician assistants). Delirium screening was added to the reminder list of required shift documentation in February 2023 (second intervention). A counterbalance measure, pressure injury risk, was chosen as a proxy for other required nursing assessments to show any unintentional downturn in other staff performance.

Results: After the bCAM redesign was introduced on June 1, 2022, delirium screening documentation decreased to 17.4% by June 30, but increased to 19.4% by July 31. After the RN educational module was implemented on July 1, delirium screening documentation increased further, to 20.7% by August, but dipped again to 13.7% by January 2023. After delirium screening was included in the required shift documentation reminder list in February 2023, delirium screening documentation significantly increased, from the baseline rate of 25.9% in May 2022 to 42.8% in March 2023 (P < 0.001) and to 47.7% in April 2023 (P < 0.001). The BPA was also associated with an increase in clinician capture of delirium diagnoses in the EHR of 47%. The rates of pressure injury risk assessment remained the same throughout the study period with only minor fluctuations.

Conclusions: In this QI project, the addition of delirium screening to shift documentation was associated with a greater than 50% increase in screening documentation, suggesting improved nurse-clinician communication. Introduction of the BPA was also associated with increased clinician capture of delirium diagnoses in the EHR. Implementing these intervention changes may improve patient outcomes and safety.

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来源期刊
CiteScore
1.10
自引率
3.70%
发文量
604
审稿时长
6-12 weeks
期刊介绍: The American Journal of Nursing is the oldest and most honored broad-based nursing journal in the world. Peer reviewed and evidence-based, it is considered the profession’s premier journal. AJN adheres to journalistic standards that require transparency of real and potential conflicts of interests that authors,editors and reviewers may have. It follows publishing standards set by the International Committee of Medical Journal Editors (ICMJE; www.icmje.org), the World Association of Medical Editors (WAME; www.wame.org), and the Committee on Publication Ethics (COPE; http://publicationethics.org/). AJN welcomes submissions of evidence-based clinical application papers and descriptions of best clinical practices, original research and QI reports, case studies, narratives, commentaries, and other manuscripts on a variety of clinical and professional topics. The journal also welcomes submissions for its various departments and columns, including artwork and poetry that is relevant to nursing or health care. Guidelines on writing for specific departments—Art of Nursing, Viewpoint, Policy and Politics, and Reflections—are available at http://AJN.edmgr.com. AJN''s mission is to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research, discussion of relevant and controversial professional issues, adherence to the standards of journalistic integrity and excellence, and promotion of nursing perspectives to the health care community and the public.
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