Abstract
Background
NICE and SIGN guidelines recommend screening of inpatients at risk of delirium using the 4AT (www.the4at.com) and communication of delirium to patients’ General Practitioners (GP). The aim of this audit was to establish whether delirium is currently being screened and documented, as recommended, in our Orthopaedic Trauma unit.
Methods
Data was collected by two junior doctors across four days (14/11/2022, 29/11/2022, 08/12/2022, 05/02/2023). Trauma and orthopaedic inpatients over the age of 65, who were more than four days post-surgery were included. Each patients’ medical notes, nursing notes, and drug Kardex was reviewed. Subsequently, all discharge letters available up until 8/2/23 were reviewed and documentation of delirium recorded.
Results
Forty patients were included in the study, of which, 29 (72.5%) were screened using the 4AT on both day-one and day-four post-operation. Of these 29 patients, 13 had delirium documented. Nine had a positive 4AT score and four had a negative 4AT score. One patient had documented delirium without a 4AT assessment. Of the 14 patients who had delirium documented, eight had delirium recorded on their discharge letter and four were yet to be discharged at the time of final data collection. Potential reasons for not using the 4AT included expressive dysphasia, review completed by a senior doctor using continuation rather than the proforma pages used by junior doctors, and documented confusion (unclear whether acute or chronic).
Conclusion
As per NICE and SIGN guidelines all patients with indicators for delirium (i.e. older trauma patients) should be screened for delirium using the 4AT. This audit identified a delirium screening rate of 72.5% in our unit. The majority of patients with delirium (8/10) had it documented on their discharge letter and thus was communicated to their GP. Further work to raise delirium awareness and confidence in delirium management in our unit is planned.