目的:确定居民急性病情恶化的临床指标以及影响老年护理机构工作人员识别这些指标的因素。
方法:快速回顾和叙事综合。
方法:WHO和Cochrane快速审查方法小组的建议指导了审查过程。CINAHL,Medline,PubMed,从2000年到2022年1月,搜索了Cochrane图书馆。使用气道对与恶化的临床指标相关的数据进行分类,呼吸,循环,残疾,暴露评估框架,影响检测的因素分为消费者(居民和家庭),老年护理劳动力,和组织因素。
结果:包括20篇出版物,其中14项知情的临床指标;影响工作人员识别这些指标的9个突出因素和3个知情因素。包括的物品总体质量低于中等质量。大多数临床指标被归入意识水平改变的“残疾”类别,行为,最常见的疼痛。很少有研究报告在一般人群中使用更传统的恶化指标-生命体征的变化。影响急性恶化检测的最常见因素是组织和劳动力相关的,包括资源,知识,和信心不足。
结论:研究结果表明居民的健康状况发生了微妙的变化,而不是主要关注急性护理环境预警工具中使用的生理参数,在设计住宅老年护理设施的预警工具时,应得到认可和考虑。
结论:建议使用对居民独特需求敏感的预警工具和对老年护理机构工作人员的支持,以提高老年护理机构护理人员早期识别和管理急性恶化以避免住院的能力。
To identify the clinical indicators of acute deterioration in residents and the factors that influence residential aged care facility staff\'s identification of these.
Rapid review and narrative synthesis.
The WHO and Cochrane Rapid Review Methods Group recommendations guided the review processes. CINAHL, Medline, PubMed, and the Cochrane Library were searched from 2000 to January 2022. Data related to clinical indicators of deterioration were categorized using the Airway, Breathing, Circulation, Disability, Exposure assessment framework, and factors influencing detection were grouped as consumer (resident and family), aged care workforce, and organization factors.
Twenty publications were included of which 14 informed clinical indicators; nine highlighted factors that influence staff\'s identification of these and three informed both. Included article were collectively below moderate quality. Most clinical indicators were grouped into the \'Disability\' category with altered level of consciousness, behavior, and pain identified most frequently. Few studies reported more traditional indicators of deterioration used in the general population - changes in vital signs. The most common factors influencing the detection of acute deterioration were organizational and workforce-related including resource, knowledge, and confidence deficits.
Findings suggest subtle changes in resident\'s health status, rather than focusing primarily on physiologic parameters used in early warning tools for acute care settings, should be recognized and considered in the design of early warning tools for residential aged care facilities.
Early warning tools sensitive to the unique needs of residents and support for aged care facility staff are recommended to improve the capacity of aged care facility care staff to identify and manage acute deterioration early to avoid hospitalization.