Abstract
Introduction
Delirium affects up to 50% of the elderly who are admitted to in-patient facilities. Delirium is preventable in 30-40% of geriatric in-patients. Trust guidance recommends an initial screening for all admissions >65, followed by continuous monitoring. This initial screening is documented using the 4AT delirium assessment tool and documented as a proforma. ‘’Do you think the patient is more confused than before ?’’ is the single question in delirium (SQiD) rated positive or negative by clinical staff on reviews. The concept of SQiD is to facilitate a quicker and easy-to-use approach to screening delirium prior to longer delirium assessment for confirmation as appropriate. This project aims to improve the adherence to delirium screening in accordance with local trust guidelines in a geriatric ward in a tertiary hospital and record the efficacy of SQiD usage.
Method
A baseline audit was conducted retrospectively from April to May to assess the adherence to trust guidelines. An educational poster to introduce SQiD and encourage the filling of proformas. In addition, brochures and face-to-face interviews were conducted with the nurses to promote the usage of SQiD. The SQiD question was incorporated into the nursing care rounds and usage was recorded from June through July. The percentage of adherence to guidelines was prospectively analyzed.
Results
Retrospectively, 9% of ward admissions had adhered to trust guidelines from months April to May. The introduction of SQiD significantly increased the filling of proformas to 88% from June through July. The number of SQiD documented increased from 0% to 89% after introducing the brochures and face-to-face interviews.
Conclusions
Although this project could be viewed as a success, the requirements for sustainability depend upon addressing limitations for the completion of proformas and ongoing training. Given SQiD’s ease of use and time efficiency, it serves good promise to improve recognition.
Comments
a closed loop adherence to delirium screening
Good audit but difficulty is probably would exclude patients admitted from care home or living alone where SQiD may not be reliable due poor quality of information from carers.