Comparison of a fall risk assessment tool with nurses’ judgment aloneDanskSygeplejeraad
1) Several studies have found that commonly used fall risk assessment tools like STRATIFY have limited diagnostic accuracy in predicting falls and do not perform better than nurses' clinical judgement alone.
2) A large randomized controlled trial found that regularly using a fall risk assessment tool in nursing homes did not reduce falls or fall-related injuries compared to usual care without a tool.
3) There is little evidence that widespread use of existing fall risk assessment tools generates meaningful clinical benefits, and they may waste scarce nursing resources that could be better spent on direct patient care.
Patientinddragende omgivelser - Fra outsider til insiderDanskSygeplejeraad
This study investigated how patients with intestinal failure experience their hospital surroundings in relation to patient participation. Eight patients were interviewed using a semi-structured method, and the interviews were analyzed using systematic text condensation. The results showed that the surroundings enabled patients to participate in their treatment and care by providing opportunities to seek information and participate in daily activities. This led patients to feel independent, reassured, in control, and confident. The study concluded that hospital surroundings are essential for supporting patient participation in their own care and that the relationship between surroundings and participation should be considered in nursing care planning.
Comparison of a fall risk assessment tool with nurses’ judgment aloneDanskSygeplejeraad
1) Several studies have found that commonly used fall risk assessment tools like STRATIFY have limited diagnostic accuracy in predicting falls and do not perform better than nurses' clinical judgement alone.
2) A large randomized controlled trial found that regularly using a fall risk assessment tool in nursing homes did not reduce falls or fall-related injuries compared to usual care without a tool.
3) There is little evidence that widespread use of existing fall risk assessment tools generates meaningful clinical benefits, and they may waste scarce nursing resources that could be better spent on direct patient care.
Patientinddragende omgivelser - Fra outsider til insiderDanskSygeplejeraad
This study investigated how patients with intestinal failure experience their hospital surroundings in relation to patient participation. Eight patients were interviewed using a semi-structured method, and the interviews were analyzed using systematic text condensation. The results showed that the surroundings enabled patients to participate in their treatment and care by providing opportunities to seek information and participate in daily activities. This led patients to feel independent, reassured, in control, and confident. The study concluded that hospital surroundings are essential for supporting patient participation in their own care and that the relationship between surroundings and participation should be considered in nursing care planning.
2. JEG ER …
Laura Krone Larsen, intensivsygeplejerske, mks,
Neurointensiv afsnit 2093, RH
Vejlederteam:
Ingrid Egerod, klinisk professor, sygeplejerske, ph.d. Traumecentret, RH
Kirsten Møller, professor i neuroanæstesiologi, læge, ph.d
Neuroanæstesiologisk klinik, RH
Marian Petersen, adjunkt, sygeplejerske, ph.d. Neurocentret, RH
3. KLINISKE REFLEKSION
•En oplevelse af at mange NIA patienter var agiterede og/eller apatiske i opvågningsfasen, og at det var svært at skelne mellem abstinenser, medicin påvirkning, post traumatisk konfusion og delirium
•Øget kendskab og fokus på delirium samt introduktion til CAM-ICU på specialuddannelsen vækkede interessen
•Hvis delirium har negative konsekvenser for almene intensivpatienter må det også påvirke patienter med en i forvejen sårbar hjerne?
4. LITTERATUR GENNEMGANG
•Et tjekkisk studie har valideret CAM-ICU til patienter med akut ICH (Mitasova et al. 2013)
•Et amerikans feasibility studie fra en traumemodtagelse, beskrev at de screenede patienter med traumatic brain injury (TBI) med CAM-iCU (Soja et al.2008)
5. ORLOV OG PROJEKTPROTOKOL
•Fik 3 måneders orlov til at udarbejde en projektprotokol. En ting er teori en anden er praksis…
•Jeg havde ingen erfaring med deliriumscreening – hvad nu?
Over 4 uger blev alle patienter over 15 år med akut erhvervet hjerneskade og en RASS -3 eller derover screenet med CAM-ICU.
6. FØRSTE ERFARINGER MED CAM-ICU PÅ NIA
•Flere patienter med RASS -3 og RASS -2 var Umulige at Vurdere (UV) grundet lavt bevidsthedsniveau / faldt hen efter 1 håndtryk og inden instrukserne var givet
•Ved RASS -1 var alle vudérbare
•Patient med impressiv afasi blev screenet falsk positiv
•Nogle få patienter ned til GCS 10-11 kunne CAM-ICU screenes.
7. INTENSIVE CARE DELIRIUM CHECKLIST (ICDSC)
Efter to uger i data indsamlings perioden besluttede jeg at også at teste ICDSC
ICDSC er baseret på DSM-IV kriterierne og består af 8 elementer, bla. Bevidsthed, hallucinationer/vrangforestillinger, opmærksomhed og søvn/vågen cyklus
Patienterne vurderes over en hel vagt (8-12 timer). Ved 4 point ud af max 8, vurderes patienten delirium positiv
8. RESULTATER
•127 observationer fordelt over 46 patienter
•25/127 observationer var det muligt at vurdere, fordelt på 15/46 patienter
•Gennemsnits data på de 46 patienter: alder: 56,9 år, GCS 7,9, RASS -3,1
•2 patienter med en GCS 10 var vurderebare, 2 patienter med GCS 11 var UV. Alle inkluderede patienter med GCS 12 eller derover var mulige at vurdere
•6/15 havde mindst én delirium positiv CAM-ICU = 40%
9. RESULTATER
•4/6 delirium positive CAM-ICU var ren hypoaktivform (RASS -1, -2)
•1/6 var blandet hypo/hyperaktivform (RASS -2, -1, +1)
•1/6 Delirium positiv hyperaktivform (RASS +2)
•Der blev foretaget 8 kontrol vurderinger med ICDSC, og i 7/8 episoder var der overensstemmelse. Eneste fravigelse skyldes at patienten fik anlagt et eksternet ventrikel dræn grundet hydrocephalus mellem de to vurderinger.
10. HVA´NU?
Dandelion
DANsk DELIrium undersøgelse af Neurointensivepatienter
Eng. DANish DELIrium study On Neurointensive care patients
11. EN KONTROLLERET FØR/EFTER UNDERSØGELSE
Baseline: 77 (vurderbare) patienter inkluderes og screenes for delirium med ICDSC og CAM-ICU.
Intervention: Implementering af interventionspakke; sedation efter target RASS, optimering af smertebehandling, tidlig mobilisering (evt sengecykel), optimering af søvn/hvile forhold.
77 patienter inkluderes og delirium screenes
12. OPFØLGNING
Pårørende eller habile patienter: udfylder EuroQoL-5D (EQ-5D) ved inklusion
6 måneder efter udskrivelse fra NIA kommer patienterne ind til fornyet EQ-5D samt Mini Mental State Examination (MMSE) og Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).