Abstract
Delirium – Getting the Basics Right on a Busy Care of the Elderly Ward
Introduction: Delirium is a disorder of attention and cognition that is commonly encountered on Care Of the Elderly wards. It is associated with a significantly increased risk of morbidity and mortality, both during and after hospital stays. Best practice guidance from NICE (National Institute for Health and Care Excellence) outlines standards for screening and preventing delirium. Where possible, appropriate preventative measures should be implemented to address underlying causes such as pain, hypoxia, constipation, and infection. However, when delirium occurs despite these measures, timely diagnosis and continued management of contributing factors are essential.
Methods: A single-cycle quality improvement project was conducted to assess the diagnosis and management of delirium in an inpatient geriatrics team. All patients aged 65 and over admitted during the trial period (April 2025 – June 2025) were included. Audits were carried out on multiple days both before and after the intervention, focusing on the use of the 4AT screening tool and the prescription of analgesia (regular or as required), oxygen, laxatives (unless contraindicated due to diarrhoea), and electrolyte replacement. The intervention consisted of a ward-based educational supported by a poster campaign.
Results: Following the intervention, there was a notable improvement in the prescription of laxatives (increasing from 70% to 87.5%), electrolyte replacement (from 81.8% to 100%), and oxygen prescription (from 36.4% to 62.5%). Prescription rates for analgesia remained consistently high both before and after the intervention. However, assessment for delirium using the 4AT tool declined post-intervention, with completion rates dropping from 54.5% to 12.5%.
Conclusions: Simple educational interventions can lead to improved implementation of preventative measures for delirium. However, screening for delirium remains suboptimal. In our patient population, if the 4AT assessment was not completed at the time of admission, it was rarely completed later during the hospital stay. Further work is needed to integrate delirium screening more consistently into routine practice.
Comments
Positive response !
Great work. 4AT score is quite useful but also one of the less performed screening tool in my Trust. In my time in Ortho-geriatrics department, we also use it as part of post operative recovery assessment as increasing confusion post hip fractures predict complications post surgery. We also noted that 4AT was not regularly completed despite part of hip fractures key performances indicators. It will be helpful to learn from your experiences about how to integrate these scores for more regular monitoring of elderly patients.
Impressive improvement in…
Impressive improvement in prescribing measures. I was curious as to whether you identified any specific barriers to consistent 4AT completion during your post-intervention period?