Construction And Application Of Evidence-based Delirium Prevention Program For Elderly Patients In ICU

Objective:In this study,Joanna Briggs(JBI)evidence-based method was used to summarize the nursing and management of delirium in ICU elderly patients,and the ORTAWA model of research use(OMRU)was used to translate the evidence into clinical practice,and evaluate its application effect.Methods:1.Based on evidence-based nursing,establish an evidence-based group,use the PIPOST problem development tool from the Fudan University Evidence-Based Nursing Center to establish initial problems,use the "6S" evidence model as a guide,retrieve guidelines,evidence summaries,systematic evaluations,expert consensus,and relevant literature on delirium management in elderly ICU patients from the past decade,evaluate the quality of the literature,extract relatively useful evidence,and summarize it into the best evidence summary for preventing delirium in elderly ICU patients.2.Using the expert group conference method,the applicability of evidence is analyzed,and the opinions of the expert group members are summarized.Under the guidance of the Ottawa Research and Application Theory,an evidence review group is established,the review indicators and review methods are determined,and combined with the clinical practice,evidence analysis is conducted on promoting factors and hindering factors in the implementation process.3.Using the method of quasi-experimental study,30 elderly patients admitted to the ICU from January 2022 to May 2022 in a tertiary hospital in Qingdao were selected as the control group,and 30 elderly patients from July 2022 to November 2022 after the introduction of evidence were selected in the observation group,and the effect of the application of evidence in three aspects: patient level,nurse level and system level was compared between the two groups.Results:1.Through literature search,a total of 2012 articles were obtained,and 18 articles that did not meet the requirements were eliminated.After the literature quality evaluation,4 low-quality literature were eliminated,and finally 14 articles were confirmed for inclusion,including 5 guidelines,1 clinical decision,4 expert consensus,3 systematic reviews,and 1 meta-analysis.By reading the literature of the included studies,57 pieces of relatively available evidence were extracted,and the evidence was summarized and analyzed,and finally formed four categories of evidence: management and training of delirium,assessment of delirium,correction of risk factors,and monitoring of delirium measures,with the best evidence summary for 17 topics.2.Twelve experts were invited to evaluate the clinical applicability of the evidence recommendations,and the expert authority coefficient was 0.84.Finally,a nursing strategy for the prevention of delirium in the elderly was developed in five aspects:management and training of delirium,assessment of delirium,correction of risk factors with common interventions,correction of risk factors by individualized interventions,and monitoring of delirium in ICU.Combined with the opinions of the review team,16 review indicators and review methods before and after the implementation of evidence were established.3.Applying the evidence to clinical practice,the results showed that:(1)patient level:the general data baseline of patients in the control group and the observation group were basically consistent,and the difference was not statistically significant(P>0.05);the incidence of delirium in the control group was 86.67%,while that in the observation group was 63.33%,and the difference value was statistically significant(P<0.05).(2)Nurse level: comparing the nurses’ mastery of the knowledge of elderly delirium in ICU before and after the application of evidence,the scores of the observation group were higher than those before the application of the evidence(P<0.05),and the implementation rate of each item was improved after the application of the evidence.(3)System level: a flow chart for delirium prevention in elderly patients was developed,the delirium knowledge training content for families and nurses was improved,and delirium videos were produced to improve the publicity effect.Conclusions:1.This study summarizes a total of 57 pieces of evidence guided by evidence-based theory,covering the specific implementation of delirium prevention in elderly patients in ICU,and provides a reliable basis for the construction of delirium prevention program in elderly patients in ICU.2.This scheme is based on the best evidence summary and based on the Ottawa application model,which can be scientifically and standardized in clinical work,and is feasible and effective.3.During the implementation of the program,the relevant knowledge level and evidence-based practice compliance of nursing staff on geriatric delirium can be improved.