Think Delirium - Act Fast

Introduction:

Delirium is a common acute presentation among older adults, particularly following acute illness or surgery e.g. neck of femur fractures. Early recognition is crucial, as delirium is associated with increased morbidity, mortality, and prolonged hospital stays. NICE guidelines recommend the use of a validated tool, 4AT, for delirium screening in all patients aged ≥65 upon admission.

Aim & Objectives:

• Compliance with 4AT screening on admission
• 4AT assessment on new onset of confusion
• Train nursing staff on 4AT screening for early identification of delirium

Methods:

Prospective data collection in two cycles: September–October 2024 (Cycle 1) and May–June 2025 (Cycle 2). Data were reviewed from electronic PICS notings. Parameters assessed included 4AT pre-admission and admission at Solihull Hospital (SH), new onset of confusion documentation and 4AT assessment.

Our interventions included educational posters on wards & offices, teaching/training for nursing staff, part of MDT discussion and Departmental Teaching.

Results:
 

Comparison of the Cycle 1 and 2:  Compliance with 4AT screening on admission at SH improved from 66% to 95%. Pre-admission 4AT completion also increased, from 32% to 52%.

In Cycle 2, 76% of 4AT assessments were performed by doctors and 19% by nurses, this marks a significant change from Cycle 1, where all 66% of assessments were conducted by doctors only.

Comparison for new onset of confusion: Cycle 1, where 6 patients were charted as having new confusion, no 4AT screening. Cycle 2, 14 patients were identified but only  2 received a 4AT assessment.

Conclusion:

Training the team is simple and cost-effective which has led to a significant improvement in compliance with 4AT delirium screening upon admission.

However, continued education to consistent 4AT tool when patients are admitted or new confusion arises. Good documentation practices are still needed to maintain progress to further enhance early identification of delirium.