背景:谵妄是医院老年人常见的并发症,康复和长期设施。
目的:评估世界范围内已验证的谵妄评估工具的使用情况和谵妄管理方案的存在。
方法:对世界谵妄意识日全球一日点患病率研究的二次分析,2023年3月15日。
方法:包括医院在内的横断面在线调查,康复和长期设施。
方法:参与的临床医生报告了谵妄的数据,协议的存在,谵妄评估,谵妄意识干预措施,非药物和药物干预措施,和病房/单位特定的障碍。
结果:来自44个国家/地区的数据,分析了1664个病房/单位和36.048名患者。验证的谵妄评估用于66.7%(n=1110)的病房/单位,18.6%(n=310)使用个人判断或没有评估,10%(n=166)使用其他评估方法。66.8%(n=1094)的病房/单位报告了谵妄管理方案。各大洲的谵妄管理方案各不相同,从非洲的21.6%(21/97病房/单位)到澳大利亚的90.4%(235/260),与使用经过验证的谵妄评估相似,非洲为29.6%(29/98),北美为93.5%(116/124).有谵妄管理方案[n=1094/1664,66.8%]的病房/单位比没有方案的病房/单位更有可能使用经过验证的谵妄测试[比值比6.97(95%置信区间5.289-9.185)]。谵妄方案的存在增加了有效谵妄评估的机会,很可能,基于证据的干预措施。
结论:报告存在谵妄管理方案的病房/单位使用经过验证的谵妄评估工具评估谵妄的可能性更高。
BACKGROUND: Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities.
OBJECTIVE: To assess the worldwide use of validated delirium assessment tools and the presence of delirium management protocols.
METHODS: Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023.
METHODS: Cross-sectional online survey including hospitals, rehabilitation and long-term facilities.
METHODS: Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers.
RESULTS: Data from 44 countries, 1664 wards/units and 36 048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol [n = 1094/1664, 66.8%] were more likely to use a validated delirium test than those without a protocol [odds ratio 6.97 (95% confidence interval 5.289-9.185)]. The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions.
CONCLUSIONS: Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium.