Delirium is a common condition in palliative care (11-40% prevalence), is often distressing for patients and families and can result in a high care burden for staff. Despite this, delirium is often under-recognised and poorly managed. National guidance and validated tools are available but more tailored approaches in palliative care may be needed; a national Delphi study is currently researching outcomes and introduction of hospice-specific guidelines can improve delirium management. Here, we describe a successful quality improvement project focussed on improved delirium care for hospice inpatients.
In 2019, we set up a multidisciplinary Delirium Working Group in response to local audit showing areas requiring improvement within delirium care. The team met monthly and comprised an advanced nurse practitioner, social worker, doctor and two occupational therapists.
The main aims were to improve inpatient delirium care, focussed on supportive and non-pharmacological measures: promoting medication use only for marked distress and risk to self/others; consistently assessing for reversible causes; communicating with patients and carers specifically about the condition; improving assessment and documentation of cognition and capacity; changing culture in order to engage the whole clinical team in recognising and collectively managing delirium.
We therefore developed a Delirium Toolkit, consisting of a ‘Step-by-Step’ checklist (accessible in electronic patient records); patient information leaflet, non-pharmacological checklist (occupational therapy-led), ‘This is Me’ document (HCA-led), 4AT tool, fuller hospice-specific guideline and NICE Quick Guide for Care Homes. This was embedded through an Awareness Week and enhanced Education Programme for each MDT group. A new induction/refresher e-learning module was developed (clinical/non-clinical versions). Delirium Champions were recruited and ‘Delirium’ is now a component of our ‘Transfer of Care Form’.
Supported by excellent buy-in from senior management and staff, this project has improved confidence across the hospice team in managing delirium. Audit results regarding toolkit use will be presented, alongside feedback and future plans involving our community teams.
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