通过姑息关怀中以患者为中心的监测系统提高谵妄护理质量:两阶段探索性顺序混合方法 MODEL-PC 研究方案

Nameer van Oosterom, M. R. Agar, Grace Walpole, Penelope Casey, Paula Moffat, Keiron Bradley, A. Cook, Claire E. Johnson, Richard Chye, Jacqueline Oehme, Maria Senatore, Claudia Virdun, Mark Pearson, I. Featherstone, Peter G. Lawlor, S. Bush, Barb Daveson, S. Clapham, Kimberley M Campbell, A. Hosie
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引用次数: 0

摘要

导言:谵妄是一种严重的急性神经认知症状,在姑息关怀病房很常见,但却未得到充分重视。为了改善这种情况下的谵妄护理,我们将开发并试行一套监测系统,该系统综合了谵妄临床护理标准、姑息关怀结果合作组织(PCOC)的方法以及患者、照护者和工作人员的观点。方法 本文报告了一项分两个阶段、探索性、顺序性混合方法实施研究的方案。第一阶段的数据收集包括谵妄标准流程图绘制和临床审计,以及对近期有谵妄经历的患者、护理人员和员工进行的关键事件技术访谈。我们将向利益相关者介绍第 1 阶段的综合调查结果,然后合作开发符合《谵妄标准》和 PCOC 方法的谵妄监测系统。在第 2 阶段,我们将对新系统进行试点,并重复第 1 阶段的数据收集和分析工作,增加 PCOC 和不良事件测量指标。我们将采用审计、反馈和教育等实施原则和策略。我们为访谈和流程图绘制参与者制定了简化的参与者信息表和同意书,参与者将提供书面知情同意;从患者病历中收集临床审核、PCOC 和不良事件数据的豁免同意书已获批准。研究结束时,我们将报告实施情况、有效性和安全性结果,包括谵妄监测系统的系统实用性,以便进行更广泛的测试和使用,从而达到姑息治疗病房的谵妄标准。定量数据分析将包括描述性和推论性统计,定性分析将包括与关键事件技术相结合的主题内容分析。混合方法数据整合将在每个阶段结束时进行。讨论 本协议文件介绍了 MODEL-PC 研究的混合方法、系统集成、创新措施和研究过程。我们还分享了数据收集工具以及简化的信息表和患者同意书。
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Driving quality in delirium care through a patient-centered monitoring system in palliative care: Protocol for the two-staged exploratory sequential mixed methods MODEL-PC study
Introduction Delirium is a serious acute neurocognitive condition that is common in palliative care units and yet under-addressed. To improve delirium care in this setting, we will develop and pilot a monitoring system that integrates the Delirium Clinical Care Standard, Palliative Care Outcomes Collaboration (PCOC) methods, and perspectives of patients, carers and staff. Methods This paper reports the protocol for a two-stage, exploratory, sequential mixed-methods implementation study. Stage 1 data collection includes Delirium Standard-aligned process mapping and clinical audits, and Critical Incident Technique interviews with patients, carers and staff with a recent experience of delirium. We will present integrated stage 1 findings to stakeholders then collaboratively develop a delirium monitoring system that aligns with the Delirium Standard and PCOC methods. In stage 2, we will pilot the new system and repeat stage 1 data collection and analyses, adding PCOC and adverse event measures. Implementation principles and strategies such as audit and feedback and education will be applied. We developed simplified participants information sheets and consent forms for interview and process mapping participants, who will provide written informed consent; and waiver of consent to collect clinical audit, PCOC and adverse event data from patients’ medical records is approved. At study end, we will report implementation, effectiveness and safety outcomes, including systemic utility of the delirium monitoring system for wider testing and use to meet the Delirium Standard in palliative care units. Quantitative data analyses will include descriptive and inferential statistics and qualitative analyses will incorporate thematic content analysis aligned to the Critical Incident Technique. Mixed methods data integration will be at the end of each stage. Discussion This protocol paper describes the mixed methods, systems integration, and innovative measures and study processes of the MODEL-PC study. We also share data collection tools and a simplified information sheet and consent form for patients.
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Informal judgement of delirium status underestimates delirium prevalence: World Delirium Awareness Day point prevalence results from Ireland The Association of Selective Serotonin Reuptake Inhibitors with Delirium in Post-Operative Adults: A Secondary Analysis of a Post-Operative Dataset with Daily Severity of Illness Adjustment Driving quality in delirium care through a patient-centered monitoring system in palliative care: Protocol for the two-staged exploratory sequential mixed methods MODEL-PC study Interprofessional Education for Delirium Management: a Quality Improvement Project Implementation of delirium management during the pandemic: lessons learned
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