Delirium on stroke units: a prospective, multicentric quality-improvement project.

Autor: Nydahl P; Nursing Science and development, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany. Peter.Nydahl@uksh.de., Baumgarte F; Christian Albrechts University Kiel, Kiel, Germany., Berg D; Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany., Bergjan M; Business Division Nursing Directorate, Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany., Borzikowsky C; Institute of Medical Informatics und Statistics, University Hospital of Schleswig-Holstein, Kiel, Germany., Franke C; Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany., Green D; Christian Albrechts University Kiel, Kiel, Germany., Hannig A; Department of Neurology, Friedrich-Ebert-Krankenhaus, Neumünster, Germany., Hansen HC; Department of Neurology, Friedrich-Ebert-Krankenhaus, Neumünster, Germany., Hauss A; Business Division Nursing Directorate, Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany., Hansen U; Department of Neurology, Diako Flensburg, Flensburg, Germany., Istel R; Christian Albrechts University Kiel, Kiel, Germany., Krämer N; Department of Neurology, Friedrich-Ebert-Krankenhaus, Neumünster, Germany., Krause K; Christian Albrechts University Kiel, Kiel, Germany., Lohrmann R; Business Division Nursing Directorate, Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany., Mohammadzadeh-Vazifeh M; Department of Neurology, Friedrich-Ebert-Krankenhaus, Neumünster, Germany., Osterbrink J; Institut für Pflegewissenschaft und-praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Austria.; Brooks College of Health, University of North Florida, Jacksonville, USA., Palm F; Department of Neurology, Heliosklinikum Schleswig, Schleswig, Germany., Petersen T; Christian Albrechts University Kiel, Kiel, Germany., Schöller B; Department of Neurology, Heliosklinikum Schleswig, Schleswig, Germany., Stolze H; Department of Neurology, Diako Flensburg, Flensburg, Germany., Zilezinski M; Business Division Nursing Directorate, Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.; University Medicine Halle (Saale), Health Service Research Working Group | Acute Care, Department of Internal Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany., Meyne J; Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany., Margraf NG; Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2022 Jul; Vol. 269 (7), pp. 3735-3744. Date of Electronic Publication: 2022 Feb 14.
DOI: 10.1007/s00415-022-11000-6
Abstrakt: Background: Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management.
Methods: Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others.
Results: Out of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6-4.7) vs. post 3.0 (2.2-4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved.
Conclusions: Implementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke.
Registry: DRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436 .
(© 2022. The Author(s).)
Databáze: MEDLINE
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