READI-SET-GO: Researching Efficient Approaches to Delirium Identification - Sustaining Effective Translation to create Gero-friendly Organizations

READI-SET-GO：研究谵妄识别的有效方法 - 维持有效的翻译以创建老年友好型组织

• 批准号: 10658578
• 负责人: DONNA Marie FICK
• 金额: $ 85万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10658578
• 关键词: 3-Dimensional; Acute; Address; Admission activity; Adopted; Adverse event; Age; Aged, 80 and over; Agitation; Alzheimer' s Disease; Alzheimer' s disease related dementia; Blinded; Caring; Certification; Cessation of life; Collaborations; Communication; Complement; Consent; Coupled; Delirium; Diabetes Mellitus; Discipline; Discipline of Nursing; Distress; Elderly; Eligibility Determination; Enrollment; Ethnic Origin; Evaluation; Family; Focus Groups; Friends; Goals; Health Care Costs; Healthcare Systems; Heart failure; Home; Hospitalization; Hospitals; Impaired cognition; Individual; Interview; Length of Stay; Medical; Methods; Nurses; Nursing Homes; Operative Surgical Procedures; Outcome; Outcome Assessment; Outcome Measure; Participant; Patient Admission; Patients; Perception; Persons; Pharmaceutical Preparations; Physical Function; Physicians; Progress Reports; Protocols documentation; Publishing; Qualitative Research; Race; Reference Standards; Registered nurse; Reporting; Research; Sampling; Stress; Subgroup; Testing; Translations; Underrepresented Minority; Underrepresented Populations; Vulnerable Populations; aspirate; care providers; clinical care; cognitive function; cohort; confusion assessment method; cost; decubitus ulcer; diagnostic tool; evidence base; falls; field study; follow-up; functional decline; future implementation; implementation design; implementation efforts; implementation facilitators; implementation strategy; improved; improved outcome; mortality; older patient; patient oriented; prospective; restraint; routine care; screening; tool; trend

ABSTRACT for READI-SET-GO Delirium has a devastating impact on older adults and their care partners. It is associated with in hospital adverse events (e.g., falls), declines in physical and cognitive function, nursing home placement and increased mortality. Despite its poor outcomes and high costs, < 50% of all delirium cases are detected in routine care. To address this challenge, in READI (Researching Efficient Approaches to Delirium Identification) we developed, validated, and field tested the Ultra-brief CAM (UB-CAM), a two-step delirium identification protocol that combines an ultra-brief 2-item screen (UB-2) with a validated diagnostic tool (3D-CAM). We enrolled 527 patients, avg. age 80 years, 35% with ADRD, at 2 study hospitals, performed reference standard delirium evaluations on 924 hospital days (153 with delirium), followed by blinded UB-CAM App-directed assessments by physicians, registered nurses, and certified nursing assistants. The UB-CAM was feasible (97% completion rate), brief (average 1 min 15 seconds), had overall accuracy of 89%, and performed well by all disciplines. We found similar positive results in the enriched subset of READI participants with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD). We simultaneously conducted qualitative research to understand barriers and facilitators to implementation of delirium screening. While READI substantially advanced the field, it did not test full scale implementation of screening among all hospitalized older adults. We now propose to take this critical next step in READI-SET-GO (READI—Sustaining Effective Translation to create Gero-Friendly Organizations) by integrating daily delirium screening using the UB-CAM into routine care for every older adult admitted to 6 acute medical/surgical units at 3 hospitals in 2 states. We will conduct a stepped-wedge implementation design, where UB-CAM screening will be launched at a new unit every 6 months over a 42-month study. We will utilize evidence-based implementation strategies and test fidelity, accuracy, sustainability, and impact. Using a pragmatic cohort of 20,000 older adults, plus a nested patient- oriented sample of 1050 older adults enriched for AD/ADRD, we propose the following Specific Aims, 1. To test the fidelity, accuracy, and sustainability of integrating daily nurse screening for delirium using the UB-CAM into routine care for all hospitalized older adults. 2. To evaluate the impact of UB-CAM delirium screening on patient and care partner centered outcomes and perceptions of care assessed at one month follow-up interviews. 3. To evaluate the impact of UB-CAM screening on rates of delirium complications (falls, pressure injury, aspiration) and adverse delirium management (psychoactive medication, restraint use). Findings from the proposed study will be readily adopted into clinical care and will directly inform best practices for delirium screening, particularly for vulnerable older individuals with AD/ADRD. Our results have the potential to make the hospital a safer place for older adults, improving outcomes and reducing distress.

Readi-set-go的摘要 妄想对老年人及其护理伙伴有毁灭性的影响。它与医院有关 不良事件（例如跌倒），身体和认知功能下降，护理家庭安置并增加 死亡。尽管结果较差和成本高，但在常规护理中发现了所有ir妄案件中的50％。 为了应对这一挑战，在Readi（研究有效的del妄方法）中 开发，验证和现场测试了两步del妄识别协议的超勃罗凸轮（UB-CAM） 这将超大型2个项目屏幕（UB-2）与经过验证的诊断工具（3D-CAM）结合在一起。我们注册了527 患者，公平。年龄80岁，ADRD的35％，在2家学习医院，进行了参考标准ir妄 对924天（153个del妄）的评估，然后进行盲目的UB-CAM APP定向评估 由医生，注册护士和认证护士助理。 UB-CAM是可行的（97％的完成 速率），简短（平均1分钟15秒），总体准确度为89％，并且所有学科的表现都很好。我们 在患有阿尔茨海默氏病和 阿尔茨海默氏病有关的痴呆症（AD/ADRD）。我们只是进行了定性研究 了解障碍和促进者来实施ir妄筛查。虽然很重要 高级领域，它没有测试所有住院老年人对筛查的全面实施。 现在，我们建议在Readi-set-go中采取这一关键的下一步 通过将UB-CAM进行日常护理整合到日常护理中，创建对Gero友好的组织） 对于每个老年人，在2个州的3家医院接受了6个急性医疗/手术单位。我们将进行 阶梯窗格实施设计，每6个新单元将在新单元启动UB-CAM筛选 在一项42个月的研究中几个月。我们将利用基于证据的实施策略并测试保真度， 准确性，可持续性和影响。使用20,000名老年人的务实队列，以及嵌套患者 - 我们提出以下特定目标的1050名老年人的面向样本， 1。测试将日常护士筛查的忠诚度，准确性和可持续性 将UB-CAM用于所有住院老年人的常规护理。 2。评估UB-CAM ir妄筛查对患者和护理伙伴的影响 在一个月的随访访谈中评估了对护理的结果和看法。 3。评估UB-CAM筛选对del妄并发症发生率的影响（跌倒，压力 伤害，抽吸）和不良del妄管理（精神活性药物，约束使用）。 拟议的研究的发现将很容易通过临床护理，并将直接告知最佳 ir妄筛查的实践，特别是对于弱势群体/ADRD的脆弱的老年人。我们的结果有 使医院成为老年人安全的潜力，改善结局并减少困扰。

项目成果

Implementing Nurse-Facilitated Person-Centered Care Approaches for Patients With Delirium Superimposed on Dementia in the Acute Care Setting.

• DOI: 10.3928/00989134-20170623-01
• 发表时间: 2017-12-01
• 期刊: Journal of gerontological nursing
• 影响因子: 1.3
• 作者: Yevchak A;Fick DM;Kolanowski AM;McDowell J;Monroe T;LeViere A;Mion L
• 通讯作者: Mion L

Less Really Is More in Inappropriate Medication Use in Older Adults: How Can We Improve Prescribing and Deprescribing in Older Adults?

老年人不适当用药的少即是多：我们如何改善老年人的处方和取消处方？

• DOI: 10.1111/jgs.16485
• 发表时间: 2020
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Fick,DonnaM

Promoting Cognitive Health: Some Good News and a Brief Summary of the Institute of Medicine Report Cognitive Aging: Progress in Understanding and Opportunities for Action.

促进认知健康：一些好消息和医学研究所报告《认知老化：理解进展和行动机会》的简要摘要。

• DOI: 10.3928/00989134-20160620-01
• 发表时间: 2016
• 期刊: Journal of gerontological nursing
• 影响因子: 1.3
• 作者: Fick,DonnaM

Barriers and facilitators to implementing delirium rounds in a clinical trial across three diverse hospital settings.

• DOI: 10.1177/1054773813505321
• 发表时间: 2014-04
• 期刊: Clinical nursing research
• 影响因子: 1.7
• 作者: Yevchak AM;Fick DM;McDowell J;Monroe T;May K;Grove L;Kolanowski AM;Waller JL;Inouye SK
• 通讯作者: Inouye SK

Using Standardized Case Vignettes to Evaluate Nursing Home Staff Recognition of Delirium and Delirium Superimposed on Dementia.

使用标准化案例小插图评估疗养院工作人员对谵妄和谵妄叠加痴呆症的识别。

• 发表时间: 2013
• 期刊: The annals of long-term care : the official journal of the American Medical Directors Association
• 作者: Fick,DonnaM;Kolanowski,AnnM;Hill,NikkiL;Yevchak,Andrea;DiMeglio,Brittney;Mulhall,PaulaM
• 通讯作者: Mulhall,PaulaM