Background Delirium has a prevalence of around 1/3 admissions to hospice inpatient units (IPUs) (Hosie, Davidson, Agar, et al., 2012). Detection and management of delirium is a priority for NICE and use of the 4AT ( https://www.the4at.com/) is recommended by the SIGN Scottish guidelines (National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management, Clinical guideline, 2010; Scottish Intercollegiate Guidelines Network. Risk reduction and management of delirium, National Clinical Guideline, 2019) Patients with delirium in acute settings have been shown to have worse outcomes and higher mortalities (Schubert, Schürch, Boettger, et al, 2018). The majority of palliative care clinicians do not use a delirium screening tool (Woodhouse, Siddiqi, Boland, et al., 2020).
Aims To implement use of a validated tool (4AT) for assessing delirium in an IPU and measure the recognition of delirium following this. To assess whether recognition of delirium changed patient outcomes.
Methods 1st cycle: Survey IPU clinical staff regarding delirium assessment. 4AT implemented for IPU admissions. Data collection on admissions including: 4AT score, age, diagnosis, comorbidities, reason for admission and outcomes.
2nd cycle: Guidance published regarding use of 4AT tool on IPU. Four teaching sessions for IPU staff. Data collection as per 1st cycle for further 1 month period. Project write up and conclusions presented to IPU staff.
Results 59% of palliative clinicians reported they do not use a delirium screening tool.
1st cycle results: 9 out of 22 appropriate patients had 4AT completed (41%). 9 out of 24 total admissions identified as having delirium (38%).
2nd cycle: 14 out of the 18 appropriate patients had 4AT completed (78%). 58% of admissions identified as having delirium. In patients with delirium 80% died and 0% went home. In patients without delirium 27% died and 27% went home. (The remaining percentage being admitted to full time care facilities.)
Conclusions The 4AT appears to have been successfully embedded on the IPU and improved identification of delirium. Utilisation of the tool was improved with further education sessions for clinical staff. This study was too small to draw definitive conclusions, but rates of delirium were very high in IPU setting and indicated delirium as a negative prognosticator in mortality and discharge destination.
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