Background Delirium is a potentially reversible condition commonly seen in patients with advanced illness. It can cause distress and often impedes communication at the end of life. When the underlying cause cannot be reversed, the symptoms can still be improved by communication, environmental modifications and pharmacological measures. However, the signs of delirium can be subtle meaning it is often under-recognised and under-treated. Introducing routine screening may help to improve identification of the condition and facilitate improvements in care.
Methods A quality improvement project was introduced over six months at one hospice unit. A baseline measure of screening on admission was performed before the introduction of four PDSA cycles to improve the detection of delirium and its management. Each cycle implemented change and then performance was evaluated through the auditing of ten patients’ admission documentation.
Results Prior to the project 0% of patients were screened for delirium on admission. This was increased to 10% following the delivery of a power-point education session. The second and third cycles aimed to introduce interventions, which would embed screening within the admission process. The delirium assessment tool – 3D-CAM and a practical delirium assessment workshop were introduced and improved screening to 70% and 89% respectively. The percentage of patients with delirium who had a plan documented (2nd cycle: 75% + 3rd cycle: 33.4%) or their diagnosis communicated to the family (2nd cycle: 50% + 3rd cycle: 33.4%) was lower. The fourth cycle aims to improve these two areas through introduction of a delirium leaflet and a second practical workshop.
Conclusion Introduction of the screening tool and a practical educational session has improved the screening of delirium. Further interventions will focus on improving management and communication. Future ambitions also include integration of the tool within the online admission documentation, with a link to online delirium guidance.
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