Background Delirium is a common yet serious condition, affecting up to 50% of all terminally ill patients (Smith & Adcock, 2011). It can be distressing for patients, carers and staff. Clinical evidence suggests that screening for delirium on admission can help improve outcomes for these patients. However, screening can often be omitted which may adversely affect patient care at the end of life (Baird & Spiller, 2017).
Aims To ascertain the current level screening for delirium in our hospice inpatient unit. To identify a validated tool for screening for delirium within a hospice setting. To implement the use of a screening tool and formally evaluate its impact on delirium screening rates.
Methods Retrospective case note review to ascertain the current rate of delirium screening on the unit. A literature review to ascertain the most appropriate validated screening tool to be used. A formal quality improvement plan (QIP) using the Plan-Do-Study-Act (PDSA) cycle with the implementation of the valid screening tool.
Results A retrospective case notes review identified that no admissions were being screened for delirium. Initially there was no improvement in screening rates by staff education alone. The literature review highlighted the 4AT as a rapid and user-friendly screening tool. The 4AT screening tool was formally introduced into the admission examination template. By November 2018 we hope to have formal data from our QIP. However, initial data has highlighted the difficulty in sustaining improved rates of screening with a validated tool alone.
Conclusions Screening for delirium on admission to hospice is important to minimise distress at the end of life (Hosker & Bennett, 2016). Formally implementing the 4AT into our admission process should increase our screening rates. Initial data suggests a difficulty in maintaining improved screening rates and therefore we will need, in addition to the 4AT, strategies to ensure consistent increased screening rates.
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