The Construction And Empirical Study Of ICU Delirium Nonpharmacological Prophylaxis Cluster Intervention Strategy

Objective:To establish ICU delirium nonpharmacological cluster intervention prevention strategies suitable for our national conditions and to evaluate the effect of the application of the ICU delirium nonpharmacological cluster intervention prevention strategies in order to provide a reference for improving the prognosis of ICU patients and to provide reference for clinical implementation of evidence-based ICU delirium nonpharmacological intervention prevention strategies at the same time.Methods:This study is divided into two parts.In the first part,this study is based on a large number of domestic and foreign literature review and evidence-based research method to preliminarily construct an ICU delirium nonpharmacological 'cluster intervention prevention strategies.All the indexes were screened by Delphi expert consultation method to determine the intervention dimensions and intervention contents of the ICU delirium nonpharmacological cluster intervention prevention strategies ultimately.The second part is to carry out and evaluate the effect of the strategies by the prospective history controlled study.A total of 45 ICU patients who were admitted to the one or two ward of Zhongda Hospital Affiliated to Southeast University from July 2017 to September 2017 in Jiangsu province and met the standard of the admission criteria were selected as the control group.A total of 45 ICU patients who were admitted to the one or two ward of Zhongda Hospital Affiliated to Southeast University from September 2017 to December 2017 in Jiangsu province and met the standard of the admission criteria were selected as the experimental group.The control group only used its routine nursing measures,the experimental group implemented the established ICU delirium nonpharmacological cluster intervention prevention strategies ESCAPE Bundle which include:early exercise,sleep management/SAT and SBT,choose the level and drugs of sedation,delirium and pain assessment,psychosis evaluation,emotional communication and exchanges.Recording the ESCAPE Bundle performing compliance of ICU nurses after intervention for 1 months and 3 months respectively.After intervention for 1 months and 3 months,the effects of ESCAPE Bundle on the treatment process and outcome indicators of two groups were analyzed and compared,and the difference of ICU ESCAPE compliance between doctors and nurses was also analyzed.Results:1.Experts' opinions tend to be consistent after two rounds of consultation.The effective response rate of the two rounds of consultation were 85.7%and 100%;the expert authority coefficients were 0.850 and 0.887;the coefficient of variation of first-grade indexes?second-grade indexes and the third-grade indexes of ICU delirium nonpharmacological cluster intervention prevention strategies were 0.068?0.145,0.093?0.239,0.087?0.249;coordination coefficient were0.48?0.35 and 0.33(P<0.01)?and ultimately determine the ICU delirium nonpharmacological cluster intervention prevention strategies ESCAPE Bundle which include:early exercise,sleep management/SAT and SBT,choose the level and drugs of sedation,delirium and pain assessment,psychosis evaluation,emotional communication and exchanges.2.In the study,45 patients were included in the experimental group and the control group respectively.The incidence of ICU delirium were 51.11%and 62.22%in the experimental group and the control respectively(x 2 =1.131,P>0.05).Delirium subtype A:the control group was mainly composed of mixed delirium,accounting for 42.86%,and the experimental group was mainly composed of active delirium,accounting for 47.83%(P>0.05).Delirium subtype B:both groups were mainly composed of persistent delirium,there was no statistical difference between the two groups(P>0.05).According to delirium severity classification,the two groups were mainly composed of moderate type delirium(P>0.05).The average duration of delirium in the experimental group was lower than that of the control group(P<0.05).In the control group,the first time of delirium occurred within 3 days after entering ICU,accounting for 45.1%,while the experimental group was mostly 7 days after entering ICU,accounting for 56.52%.The first occurence of delirium in the experimental group after ICU was later than that in the control group.Comparison of two groups of patients' treatment process index:two groups of patients during the ICU period,there was no significant difference in the total dose of dexmedetomidine and propofol.The total use of remifentanil in the experimental group was lower than that in the control group(P<0.05).After 3 months of the intervention,the number of days for reaching the standard of the light sedation level,the number of days for reaching the standard of pain score,the standard proportion of ICU delirium assessment were significantly higher than those in the control group(P<0.05).The first time of ICU getting out of bed in the experimental group was earlier than that of the control group(P<0.05).The time of ICU mechanical ventilation and the time of ICU hospitalization in the experimental group were less than that of the control group(P<0.05).Total hospitalization time,ICU mortality and discharge mortality in two groups of patients(P>0.05).After 3 months of intervention,the ICU sleep quality score and the ICU cognitive function score in the experimental group were all greater than those in the control group(P<0.05).The compliance rate of the ESCAPE Bundle in the experimental group was increased from 1 months after the intervention of 37%up to 3 months after the intervention of 61%(P<0.05).Conclusions:This study based on evidence-based research method and Delphi expert consultation method preliminary constructed the ICU delirium nonpharmacological cluster intervention strategies ESCAPE Bundle which include:early exercise,sleep management/SAT and SBT,choose the level of sedation and drugs,delirium and pain assessment,psychiatric evaluation,emotional communication,and communication.Through clinical practice we found that the incidence of ICU delirium can not be reduced effectively three months after implementing the strategies,but the strategies can significantly reduce the duration of ICU delirium,the ICU mechanical ventilation time and the ICU length of hospital stay,improve the cognitive function scores and sleep quality scores when the patients leave ICU.The strategies have a tendency to improve the patients' survival rate.The implementation of ESCAPE Bundle by the team based on multi-disciplinary cooperation can improve the compliance of ESCAPE Bundle and improve the prognosis of patients.