Improving Multidisciplinary Delirium Assessment and Documentation Using the 4AT on an Acute Geriatric Ward

Background: Delirium is a common complication of hospitalisation in older adults and is associated with increased mortality, prolonged hospital stay and functional decline. Although routine screening using the 4AT is recommended, delirium assessment and documentation remain inconsistent. Baseline auditing identified poor ward-based 4AT completion, with assessments predominantly undertaken by medical staff despite the multidisciplinary nature of geriatric care.

Aim: To improve multidisciplinary recognition, assessment and documentation of delirium by increasing staff knowledge, confidence and appropriate use of the 4AT through a targeted educational intervention.

Methods: A two-cycle quality improvement project was conducted on an acute geriatric ward. Cycle 1 audited 23 patients against five standards: admission 4AT completion, ward-based 4AT completion, delirium recognition, documented management plan and repeat cognitive assessment. A multidisciplinary educational intervention comprising teaching sessions, an educational poster and reinforcement of the correct electronic documentation pathway was delivered to doctors, nurses and healthcare assistants (HCAs). Staff knowledge and confidence were evaluated using pre- and post-intervention questionnaires before re-auditing 18 patients.

Results: Ward-based 4AT completion increased from 13.0% to 44.4%. Delirium recognition improved from 82.6% to 100%, documented management plans from 82.6% to 100%, and repeat cognitive assessment from 56.5% to 72.2%. Staff questionnaires demonstrated increased confidence in recognising delirium, improved knowledge of the electronic documentation pathway and greater use of validated screening tools. The intervention also broadened multidisciplinary ownership of delirium care by empowering nurses and HCAs to identify delirium, prompt formal assessment and contribute to documentation, reducing reliance on medical staff.

Conclusions: A simple, low-cost educational intervention improved multidisciplinary engagement with delirium screening, resulting in better ward-based assessment, documentation and ongoing management. A key barrier was electronic patient record permission restrictions preventing trained HCAs from independently completing the 4AT. Extending documentation privileges alongside continued multidisciplinary education may further improve delirium screening and strengthen patient care across the acute admission pathway.