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Gepubliceerd in: Tijdschrift voor Gerontologie en Geriatrie 1/2008

01-02-2008 | Artikel

Opvattingen van artsen en verpleegkundigen over de preventie, diagnose en behandeling van delirium

Auteurs: L. Verstraete, E. Joosten, Prof. dr. K. Milisen

Gepubliceerd in: Tijdschrift voor Gerontologie en Geriatrie | Uitgave 1/2008

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Samenvatting

Deze survey wil zicht krijgen op de opvattingen van ziekenhuisartsen en verpleegkundigen over de preventie, diagnose en behandeling van delirium. Vragenlijsten werden verspreid aan 2256 verpleegkundigen en 982 artsen werkzaam binnen de Universitaire Ziekenhuizen van Leuven (UZ Leuven). De respons bedroeg 26% met een totaal van 819 bruikbare vragenlijsten (600 verpleegkundigen; 219 artsen). 72% van alle respondenten oordeelde dat delirium geen tot een minimaal probleem was op hun afdeling. Toch vond meer dan de helft van de medewerkers op de afdeling palliatieve zorg (87%, n=15), traumatologie (67%, n=18), cardio-thoracale chirurgie (58%, n=20), intensieve zorg (55%, n=120) en geriatrie (55%, n=42) het een ernstig probleem. Delirium werd beschouwd als een ondergediagnosticeerd (85%), te voorkomen syndroom (75%). Risicopatiënten werden echter zelden (34%) tot nooit (52%) gescreend op delirium. Gebeurde dit toch (48%), dan gebruikte slechts 4% een specifiek gevalideerd meetinstrument.
97% van alle respondenten vond dat delirium een actieve en onmiddellijke interventie van de verpleegkundige en de zaalarts vereiste. Bij een delirium gebruikte 82% van de artsen haldol®, in het geval van een delirium tengevolge van alcohol of benzodiazepine onttrekking prefereerde 69% tranxène®. Het gebruik van fysieke fixatie bij onrustige, geagiteerde patiënten was belangrijk voor een groter aandeel verpleegkundigen (49%) dan artsen (28%).
Conclusie: de ernst van het probleem wordt vaak onderschat. Hoewel de behandeling meestal correct wordt ingesteld, moet verder geïnvesteerd worden in de preventie en de vroegtijdige detectie van delirium.
Literatuur
1.
go back to reference American Psychiatric Association (APA). Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999; 156(Mei suppl):1-20. American Psychiatric Association (APA). Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999; 156(Mei suppl):1-20.
2.
go back to reference Kiely DK, Bergmann MA, Jones RN, Murphy KM, Orav EJ, Marcantonio ER. Characteristics associated with delirium persistence among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci 2004; 59(4): 344-349. Kiely DK, Bergmann MA, Jones RN, Murphy KM, Orav EJ, Marcantonio ER. Characteristics associated with delirium persistence among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci 2004; 59(4): 344-349.
3.
go back to reference Rockwood K. Delirium and frailty. Primary Psychiatry 2004; 11(11): 36-39. Rockwood K. Delirium and frailty. Primary Psychiatry 2004; 11(11): 36-39.
4.
go back to reference Cole MG. Delirium in elderly patients: clinical review. Am J Geriatr Psychiatry 2004; 12: 7-21. Cole MG. Delirium in elderly patients: clinical review. Am J Geriatr Psychiatry 2004; 12: 7-21.
5.
go back to reference Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. JAGS 2003; 51: 4-9. Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. JAGS 2003; 51: 4-9.
6.
go back to reference Litton KA. Delirium in the critical care patient. What the professional staff needs to know. Crit Care Nurs Q 2003; 26(3): 208-213. Litton KA. Delirium in the critical care patient. What the professional staff needs to know. Crit Care Nurs Q 2003; 26(3): 208-213.
7.
go back to reference Milisen K, Foreman MD, Godderis J, Abraham IL, Broos PLO. Delirium in the hospitalised elderly: nursing assessment and management. Nurs Clin North Am 1998; 33(3): 417-439. Milisen K, Foreman MD, Godderis J, Abraham IL, Broos PLO. Delirium in the hospitalised elderly: nursing assessment and management. Nurs Clin North Am 1998; 33(3): 417-439.
8.
go back to reference Schuurmans MJ, Duursma SA, Shortridge-Baggett LM. Early recognition of delirium: review of the literature. J Clin Nurs 2001; 10: 721-729. Schuurmans MJ, Duursma SA, Shortridge-Baggett LM. Early recognition of delirium: review of the literature. J Clin Nurs 2001; 10: 721-729.
9.
go back to reference Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753-1762. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753-1762.
10.
go back to reference McCusker J, Cole MG, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002; 162: 457-463. McCusker J, Cole MG, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002; 162: 457-463.
11.
go back to reference Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Impact on different diagnostic criteria on prognosis of delirium: a prospective study. Dement Geriatr Cogn Disord 2004; 18: 240-244. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Impact on different diagnostic criteria on prognosis of delirium: a prospective study. Dement Geriatr Cogn Disord 2004; 18: 240-244.
12.
go back to reference Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27(12): 1892-1900. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27(12): 1892-1900.
13.
go back to reference McCusker J, Cole MG, Dendukuri N, Belzile E. Does delirium increase hospital stay? JAGS 2003; 51: 1539-1546. McCusker J, Cole MG, Dendukuri N, Belzile E. Does delirium increase hospital stay? JAGS 2003; 51: 1539-1546.
14.
go back to reference Saravay SM, Kaplowitz M, Kurek J, et al. How do delirium and dementia increase length of stay of elderly general medical inpatients? Psychosomatics 2004; 45(3): 235-242. Saravay SM, Kaplowitz M, Kurek J, et al. How do delirium and dementia increase length of stay of elderly general medical inpatients? Psychosomatics 2004; 45(3): 235-242.
15.
go back to reference Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo-Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. JAGS 2005; 53: 405-409. Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo-Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. JAGS 2005; 53: 405-409.
16.
go back to reference Inouye, SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalised elderly medical patients. Am J Med 1994; 97: 278-288. Inouye, SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalised elderly medical patients. Am J Med 1994; 97: 278-288.
17.
go back to reference Pun BT, Ely EW. The delirium dilemma in the intensive care unit: current concepts in monitoring and management. Primary Psychiatry 2004; 11(11): 59-64. Pun BT, Ely EW. The delirium dilemma in the intensive care unit: current concepts in monitoring and management. Primary Psychiatry 2004; 11(11): 59-64.
18.
go back to reference Weber JB, Coverdale JH, Kunik ME. Delirium: current trends in prevention and treatment: review. Intern Med J 2004; 34: 115-121. Weber JB, Coverdale JH, Kunik ME. Delirium: current trends in prevention and treatment: review. Intern Med J 2004; 34: 115-121.
19.
go back to reference Kalisvaart CJ, Vreeswijk R, de Jonghe JFM, Milisen K. Een systematisch overzicht van multifactoriële interventies ter primaire preventie van delier bij ouderen. Tijdschr Gerontol Geriatr 2005; 36: 224-231. Kalisvaart CJ, Vreeswijk R, de Jonghe JFM, Milisen K. Een systematisch overzicht van multifactoriële interventies ter primaire preventie van delier bij ouderen. Tijdschr Gerontol Geriatr 2005; 36: 224-231.
20.
go back to reference Milisen K, Lemiengre J, Braes T, Foreman M. Multicomponent intervention strategies for managing delirium in hospitalised older people: a systematic review. J Adv Nurs 2005; 52(1):79-90. Milisen K, Lemiengre J, Braes T, Foreman M. Multicomponent intervention strategies for managing delirium in hospitalised older people: a systematic review. J Adv Nurs 2005; 52(1):79-90.
21.
go back to reference Siddiqi N, Stockdale R, Britton AM, Holmes J. Interventions for preventing delirium in hospitalised patients (review). The Cochrane Database of Systematic Reviews 2007; Issue 2. Siddiqi N, Stockdale R, Britton AM, Holmes J. Interventions for preventing delirium in hospitalised patients (review). The Cochrane Database of Systematic Reviews 2007; Issue 2.
22.
go back to reference Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999; 106: 565-573. Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999; 106: 565-573.
23.
go back to reference Francis J. Historical overview of investigations into delirium. Primary Psychiatry 2004; 11: 31-35. Francis J. Historical overview of investigations into delirium. Primary Psychiatry 2004; 11: 31-35.
24.
go back to reference Rockwood K, Bhat R. Should we think before we treat delirium? Intern Med J 2004; 34: 76-78. Rockwood K, Bhat R. Should we think before we treat delirium? Intern Med J 2004; 34: 76-78.
25.
go back to reference Ely EW, Stephens RK, Jackson JC, et al. Current opinions regarding the importance, diagnosis and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 2004; 32(1):106-112. Ely EW, Stephens RK, Jackson JC, et al. Current opinions regarding the importance, diagnosis and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 2004; 32(1):106-112.
26.
go back to reference American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 4th ed.-revised. American Psychiatric Association. Washington DC, 2000: 943. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 4th ed.-revised. American Psychiatric Association. Washington DC, 2000: 943.
27.
go back to reference Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113(12): 941-948. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113(12): 941-948.
28.
go back to reference Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract 2003; 17(1): 31-50. Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract 2003; 17(1): 31-50.
29.
go back to reference Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM Confusion Scale: construction, validation and clinical testing. Nurs Res 1996; 45(6): 324-330. Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM Confusion Scale: construction, validation and clinical testing. Nurs Res 1996; 45(6): 324-330.
30.
go back to reference Lindesay J, Rockwood K, Rolfson D. The epidemiology of delirium. In: Lindesay J, Rockwood K, MacDonald A, eds. Delirium in old age. Oxford, UK: Oxford University Press, 2002. Lindesay J, Rockwood K, Rolfson D. The epidemiology of delirium. In: Lindesay J, Rockwood K, MacDonald A, eds. Delirium in old age. Oxford, UK: Oxford University Press, 2002.
31.
go back to reference McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. JAGS 2003; 51: 591-598. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. JAGS 2003; 51: 591-598.
32.
go back to reference Lawlor PG, Gagnon B, Mancini IL, et al. Occurrence, causes and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000; 160: 786-794. Lawlor PG, Gagnon B, Mancini IL, et al. Occurrence, causes and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000; 160: 786-794.
33.
go back to reference Cobb JL, Glantz MJ, Nicholas PK, et al. Delirium in patients with cancer at the end of life. Cancer Practice 2000; 8(4): 172-177. Cobb JL, Glantz MJ, Nicholas PK, et al. Delirium in patients with cancer at the end of life. Cancer Practice 2000; 8(4): 172-177.
34.
go back to reference Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 2001; 161: 2467-2473. Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 2001; 161: 2467-2473.
35.
go back to reference Foreman MD, Milisen K. Improving recognition of delirium in the elderly. Primary Psychiatry 2004; 11(11): 46-50. Foreman MD, Milisen K. Improving recognition of delirium in the elderly. Primary Psychiatry 2004; 11(11): 46-50.
36.
go back to reference Meagher DJ. Clinical review. Delirium: optimising management. BMJ 2001; 322: 144-149. Meagher DJ. Clinical review. Delirium: optimising management. BMJ 2001; 322: 144-149.
37.
go back to reference Evans D, Wood J, Lambert L A review of physical restraint minimization in the acute and residential care settings. J Adv Nurs 2002; vol. 40(6): 616-625. Evans D, Wood J, Lambert L A review of physical restraint minimization in the acute and residential care settings. J Adv Nurs 2002; vol. 40(6): 616-625.
38.
go back to reference Mott S, Poole J, Kenrick M. Physical and chemical restraints in acute care: their potential impact on the rehabilitation of older people. Int J Nurs Pract 2005; 11(3): 95-101. Mott S, Poole J, Kenrick M. Physical and chemical restraints in acute care: their potential impact on the rehabilitation of older people. Int J Nurs Pract 2005; 11(3): 95-101.
39.
go back to reference Kalisvaart KJ, de Jonghe JF, Bogaards MJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. JAGS 2005; 53(10): 1658-1666. Kalisvaart KJ, de Jonghe JF, Bogaards MJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. JAGS 2005; 53(10): 1658-1666.
40.
go back to reference Lonergan E, Britton AM, Luxenberg J, Wyller T. Haloperidol for delirium: protocol. The Cochrane Database of Systematic Reviews 2004; Issue 4. Lonergan E, Britton AM, Luxenberg J, Wyller T. Haloperidol for delirium: protocol. The Cochrane Database of Systematic Reviews 2004; Issue 4.
41.
go back to reference Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164(13): 1405-1412. Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164(13): 1405-1412.
42.
go back to reference Puffer S, Rashidian A. Practice nurses’ intentions to use clinical guidelines. J Adv Nurs 2004; 47(5): 500-509. Puffer S, Rashidian A. Practice nurses’ intentions to use clinical guidelines. J Adv Nurs 2004; 47(5): 500-509.
43.
go back to reference Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines: a framework for improvement. JAMA 1999; 282(15): 1458-1465. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines: a framework for improvement. JAMA 1999; 282(15): 1458-1465.
44.
go back to reference Kingma JH. De oudere patiënt met een delirium in het ziekenhuis: verwardheid nog onvoldoende onderkend. Inspectierapport gezondheidszorg. Den Haag, 2005. Kingma JH. De oudere patiënt met een delirium in het ziekenhuis: verwardheid nog onvoldoende onderkend. Inspectierapport gezondheidszorg. Den Haag, 2005.
Metagegevens
Titel
Opvattingen van artsen en verpleegkundigen over de preventie, diagnose en behandeling van delirium
Auteurs
L. Verstraete
E. Joosten
Prof. dr. K. Milisen
Publicatiedatum
01-02-2008
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Tijdschrift voor Gerontologie en Geriatrie / Uitgave 1/2008
Print ISSN: 0167-9228
Elektronisch ISSN: 1875-6832
DOI
https://doi.org/10.1007/BF03078120

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