Improving Delirium Screening Within 24 Hours of Admission: A Quality Improvement Project on an Acute Frailty Unit

Introduction
Delirium is associated with significant morbidity, prolonged hospitalisation and adverse outcomes. Assessment of delirium risk factors and potential causes within 24 hours of admission was inconsistent on our acute frailty unit. Staff feedback identified limited confidence, unclear ownership of screening, variable access to screening tools and inconsistent assessment of pain and nutrition as key barriers.

Method
A quality improvement project assessed compliance with comprehensive delirium assessment within 24 hours of admission. Documentation was reviewed for 15 patients per cycle admitted with delirium via the emergency department to the acute frailty unit. Assessments of hydration, constipation, pain, nutrition, and medication-related risk factors were reviewed against BGS and NICE guidance. Interventions included dissemination of NICE delirium guidance, a Cerner delirium checklist, targeted teaching for medical staff and educational posters. A second PDSA cycle was subsequently undertaken.

Results
Following intervention, considerable improvements were demonstrated across all measured components. Comprehensive geriatric assessment increased from 5/15 (33%) to 13/15 (87%), constipation assessment from 6/15 (40%) to 14/15 (93%), and dehydration assessment from 8/15 (53%) to 15/15 (100%). Pain optimisation improved from 1/15 (7%) to 12/15 (80%), while medication review increased from 3/15 (20%) to 9/15 (60%).

Conclusion
Baseline assessment identified significant gaps in delirium screening, particularly pain and medication review. A structured QI approach, including electronic prompts, staff education, and increased awareness, was associated with marked improvement across all measured domains. Further work ought to focus on embedding delirium screening within electronic systems, clarifying responsibility for assessment and extending the intervention across geriatric wards.