Establish Prevent Strategies For Bundles Of Care And Study On Clinical Application For Patient Of ICU Syndrome

Intensive Care Unit syndrome (short for ICU syndrome)is a kind ofcommon ICU complications. It is mainly manifested as delirium, which iscognitive processes obstacles of patient’s brain.The original spirit state ofacute changes or a fluctuating process, distractibility, thinking collapse orchange in level of consciousness, is the patient’s own disease intertwinedwith the external environment factors due to psychiatric symptoms.Domestic ICU medical staff pay more attention to the diagnosis andtreatment of patients with pre-existing illness, and pay less attention to theICU syndrome. Moreover, there is no quick and easy assessment tool.According to foreign studies show that early diagnosis and treatment forICU syndrome can improve the prognosis. So in this study, the test ICUsyndrome screening scale reliability and validity into three parts.Eventually establish the ICU syndrome care cluster intervention strategies.Part I：Objective：Explore the reliability and validity of the Chineseversion of nursing delirium screening scale in the early screening ICUsyndrome. Method: using Chinese version of the NU-DESC scale goldstandard "Diagnostic and Statistical Manual of Mental Disorders，FourthEdition，DSM-IV " to diagnose delirium of the same patient. Result：intraclass correlation coefficient （ICC） of Chinese version of the NU-DESC scale total score is0.91（P<0.01）, when taking2into screeningcut-off value, the sensitivity is0.91（95%CI：0.76-0.98），specificity is0.84（95%CI：0.70-0.83），value of Kappa is0.73（P<0.01），diagnosis rateis87.3%. When taking3into screening cut-off value, the sensitivity is0.81（95%CI：0.65-0.97），specificity is0.93（95%CI：0.88-0.96）valueof Kappa is0.79（P<0.01），diagnosis rate is91.2%. Conclusion：Chineseversion of the NU-DESC scale reliability and validity works in ICUsyndrome screening and diagnosis.Part II：Objective: Discussing on ICU delirium and sleep disordersincident and the influence on patient at night using goggles and earplugswho were the initial occupancy in ICU. Method：Randomized136casesof enrolled patients, then using Chinese version of nursing deliriumscreening scale to scale delirium, testing sleep disorders for two groups ofpatients by Pittsburgh Sleep Quality Index(PSQI), statistically analyzingon the observations through audio-visual isolation and control groups.Result：Audio-visual isolation groups delirium incidence and time ofoccurrence are less than the control group HR=0.47（95%，CI0.27~0.82）.Moreover, sleeping time and quality were significantly different betweentwo groups(P<0.01). Conclusion：Using eyeshade and noise earplugsat night can effectively reduce the incidence of ICU delirium.Part III: Objective: Discussing on establish bundles of Careintervention strategies of the ICU syndrome through the introduction ofICU care team leader in the implementation of the cluster interventionstrategies to prevent the ICU syndrome. Method：Development and implementation of strategies for bundles of care to prevent Intensive CareUnit syndrome base on preliminary evidence-based research. Established aquality control team composed by the nursing team leader. Organizationalguarantee through the implementation of the learning, training,applications and quality control. Compared ICU syndrome cases, theduration of delirium, the average length of stay, patient satisfaction of twogroups. Result：There are4samples of ICU syndrome happened inBundles of Care intervention group,which quality control by the nursingteam leader. The disease incidence is7.8％. In addition, there are8samples in control group, the disease incidence is14.9％. Compared thedelirium number of cases, the duration of delirium, ICU length of stay andpatient satisfaction between the two groups, there are significant differencesin P <0.05. Conclusion：There is more targeted and effectively usingstrategies for bundles of care as an active prevention measures thantraditional passive prevention. The care leader can promote bundles of careprevention put in place. Thereby effectively reducing the ICUcomplications syndrome.