Background Involvement of an organisation in research contributes important data towards answering the research question, but can also have significant benefits for the participating organisation outside of the study question. At Farleigh Hospice, we are currently involved in the CHELsea II study, a national cluster randomised control trial looking at whether supplementary fluids at the end of life are effective at reducing the incidence and severity of delirium. This has allowed us to evaluate our current management of delirium on the Inpatient Unit (IPU) and to make improvements.

Method We designed and conducted a Quality Improvement project to broadly improve delirium recognition and care on the IPU. Through several cycles we introduced multiple small changes such as screening tools, education sessions, items to improve the physical environment and information leaflets for families. Our main endpoint was to measure the confidence of staff in managing patients with delirium, as developing their skills and experience was felt to be a more longer-lasting and impactful change. This was assessed via a questionnaire completed at baseline and then after 1 year.

Results We surveyed a range of staff working on the IPU, including nurses, doctors and healthcare assistants. At baseline only 55.6% of respondents felt confident recognising the symptoms of delirium, and 33.3% felt confident with managing a patient with delirium. Following the above interventions, 88.9% and 100% of respondents now feel confident for both of these areas respectively. We aim to consolidate these skills and continue making long-lasting changes.

Conclusion Through participating in a national research study, we have been able to shine a light on our own local practices. By undertaking cumulative small changes we have developed a more experienced and confident workforce who can continue to build on these skills throughout their careers and thus have an enduring impact.