Development and Evaluation Clinical Practice Guidelines for Prevention of Delirium Among Critically Ill Patients, Medicine Ward 3, Lampang Hospital
Keywords:
Clinical Practice Guidelines, Prevention ICU Delirium, Critically Ill PatientAbstract
This developmental research aims to develop clinical practice guidelines (CPGs) for prevention delirium in critically ill patients, Lampang Hospital. The study was based on the CPGs implementing framework of the Australian National Health and Medical Research Council (NHMRC, 1999). The sample was selected as the patients who conscious and able to communicate patients, From the Richmond Agitation and Sedation Scale (RASS > -3 score). Subjects included 121 conscious patients, who were confined in Medicine Ward 3 before implementing of CPGs, and 106 subjects who were confined after implementing of CPGs. The instruments used in this study were CPGs for prevention of delirium among critically ill patients and a record form of the incidence of delirium in critically ill patients. Data analyses was done using descriptive statistics, percentage, mean, standard deviation and compare the data before and after using CPGs general data with independent t-test, exact probability test and incidence rate of delirium with multi variable risk difference regression statistics.
The CPGs consisted of six domains 1) patient protection and ethics 2) risk factor and prevention for ICU delirium by the application and The Confusion Assessment Method for the Intensive Care Unit [CAM-ICU] 3) Prevention by using non-pharmacology preventive measures in care bundle ABCDEF 4) Educating health team personnel 5) continuous monitoring and recording and 6) service quality improvement. The finding revealed that the incidence rate of ICU delirium among subjects in the CPGs group was 15 cases 14.2% and the average duration of the incidence (Mean) is 0.9 shift per case while the incidence rate of ICU delirium among subjects in the non-CPGs group was 42 cases only 34.7% and the average duration of the incidence (Mean) is 4.5 shift per case. By the incidence of P-value 0.071, resulting in less than 7-16.2% and the average duration of the incidence (Mean) value P-value < 0.001.
This study confirmed that implementing the CPGs was able to reduce the incidence rate of ICU delirium and the average duration of incidence (Mean). The investigator suggests these CPGs should be incorporated with quality improvement activities among another Ward.
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