Creating a delirium-friendly space: improving environmental factors on a Care of the Elderly ward

Background

Delirium is an acute neuropsychiatric syndrome characterised by fluctuating cognition, consciousness, and attention, affecting up to 55% of older inpatients. It is associated with falls, prolonged admission, functional decline, mortality, and long-term cognitive impairment. Environmental factors such as disorientation, sensory deprivation, noise, disrupted sleep, and poor lighting increase delirium risk, particularly among frail or cognitively impaired patients. NICE CG103 recommends orientation aids (clocks, calendars, signage, lighting, and family contact) as key delirium prevention measures, yet these are often inconsistently implemented. We aimed to assess and improve modifiable environmental factors contributing to delirium risk on our Care of the Elderly (CoE) ward.
SMART aim: Within six months, ensure 100% of patient bed spaces had visible clocks, accurate date/time displays, and clear signage identifying the ward and hospital.

Method

This six-month prospective quality improvement project was conducted on a 30-bed CoE ward at Lister Hospital, Stevanage, UK. Each bed space was assessed for:

1. Visibility of a clock.
2. Visibility of correct date and time.

3. Visibility of ward/hospital signage.

   Interventions followed three PDSA cycles: repositioning and installing new clocks, correcting dates/times, and implementing standardised signage. Sustainability was promoted via staff engagement at departmental governance meetings.

Results

Baseline (January 2025): visible clock from 30%, correct date/time from 16%, and signage from 60% of bed spaces, respectively.
Post-intervention (August 2025):

• Clocks visible from 100% of bed spaces.
• Correct time visible from 100%, correct date from 70%.
• Signage of ward and hospital in large font were visible from 100%.
  This represents a substantial improvement in environmental orientation factors.

Conclusion

Simple, low-cost environmental modifications improve compliance with NICE delirium prevention standards. Optimising orientation cues enhances patient experience and may reduce delirium incidence. This sustainable, replicable framework has since been adopted across additional CoE wards in our hospital, reinforcing the importance of environmental factors in delirium prevention and patient safety.