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Aus der Praxis – für die Praxis

Delirprävention und -management

Erarbeitung und Implementierung eines nicht-pharmakologischen Maßnahmenkatalogs im Akut-Setting

Published Online:March 25, 2022https://doi.org/10.1024/1012-5302/a000880

Abstract

Zusammenfassung.Hintergrund: Im Oktober 2018 wurde ein Projekt zur Umsetzung eines Delirmanagements in einem Universitätsklinikum für Herz-Kreislauf-Erkrankungen initiiert. Im Rahmen eines multiprofessionellen Ansatzes wurde der aus hochschulisch qualifizierten Pflegenden bestehende Arbeitskreis Evidence-based Nursing (AK EBN) in dieses Projekt eingebunden. Problemstellung und Zielsetzung: Ziel des AK EBN war herauszufinden, welche nicht-pharmakologischen Maßnahmen zur Delirprophylaxe wirksam sind und welchen Einfluss diese auf die Delirrate von Patient_innen im Krankenhaus haben. Methode: Die Bearbeitung der Fragestellung erfolgte nach der EbN-Methode. Es wurden das PIKE-Schema (Behrens & Langer, 2016) sowie Instrumente zur Beurteilung von Forschungsarbeiten herangezogen. Relevante Studien wurden anschließend im AK EBN aufbereitet und die Ergebnisse zusammengetragen. Ergebnisse: Trotz einer heterogenen Studienstruktur gibt es aussagekräftige Evidenz, dass die Umsetzung von Maßnahmenbündeln zu einer Senkung der Delirrate beitragen kann. Dazu zählen z.B. Aspekte zur Orientierung und die Lärmvermeidung. Es wurden ein nicht-pharmakologischer Maßnahmenkatalog, Kommunikationshilfsmittel und ein Leitfaden zur Einbindung von Bezugspersonen zur Prävention und Behandlung eines Delirs entwickelt. Ergänzend folgen regelmäßige Fortbildungen durch den AK EBN. Schlussfolgerung: Zur Förderung einer erfolgreichen Implementierung von Projekten in der Praxis ist die Einbindung beteiligter Beschäftigter wichtig. Im Rahmen eines Skill-Grade-Mixes konnten Pflegende in diesem multiprofessionellen Projekt einen wichtigen Beitrag leisten.


Delirium prevention and management: Development and implementation of a non-pharmacological catalog of measures in the acute setting

Abstract.Background: In October 2018, a new delirium management concept was developed in a university hospital for cardiovascular diseases. As part of a multi-professional approach, the previously established “Evidence-based Nursing working group (AK EBN)”, consisting of academically qualified nurses from the hospital, was involved in the implementation process. Aim: The AK EBN aimed to identify effective non-pharmacological interventions to prevent and treat delirium and to establish how these interventions could influence delirium rates in hospital patients. Methods: The EbN method was employed to address the study question applying the PICO framework (Behrens & Langer, 2016) as the bases for systematic searches in different databases. Relevant studies were identified, data were extracted, displayed in tables and discussed within the AK using established critical appraisal tools for quality assessment. Results: Despite a heterogeneous study sample, results showed that there is meaningful evidence for the effectiveness of intervention bundles on the reduction of delirium rates. Bundles include for example, aspects of orientation and noise reduction. As a result, a catalogue of non-pharmacological interventions, communication aids, and a guide for involving caregivers in the prevention and treatment of delirium were developed. Additionally, continuing training events held by the participants of AK EBN were organized. Conclusions: To promote the successful implementation of projects in practice, the involvement of all stakeholders is important. As part of a skill-grade-mix, nurses made an important contribution in this multi-professional project.

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