Background Delirium is a significant problem in the palliative care setting, with incidence of delirium ranging from 5%–45% of inpatients (Hosie et al., 2013). In Scotland there has been development of a new management pathway for delirium by Healthcare Improvement Scotland and the Scottish Delirium Association (2016). This recommends the use of the 4AT to help diagnose delirium.
Aims This is an audit to review the practice of screening for delirium in the hospice setting. The aim of the audit is to ensure delirium assessment in the hospice is in line with current guideline. The standard is that 100% of patients over the age of 65 should have a documented cognitive screen on admission.
Methods Notes from patients admitted from 19 June to 19 November 2015 were retrospectively reviewed to assess for formal documentation of delirium screening and also the incidence of delirium in this population. Patients over the age of 65 were included and patients that were admitted for care in the last days of life were excluded from the data. Stage two involved the introduction of the 4AT in the above inpatient population. The use of the 4AT was then re-audited in patients who were admitted to the hospice in the following six months.
Results Prior to the intervention only three out of 38 patients had formal assessment of delirium on admission. Post intervention 26/29 patients had formal assessment with the use of the 4AT. 58% patients who were admitted over this year period and fitted the inclusion criteria developed a delirium during their stay.
Conclusion This audit has shown that education and introduction of simple routine assessment can increase the recognition of delirium in a palliative care setting, potentially improving levels of care for patients.