Abstract
Introduction: Delirium is common in hospital inpatients, under-recognised, and associated with increased morbidity and mortality. NICE quality standards are that all at-risk adults newly admitted to hospital receive tailored interventions to prevent delirium.
Aims: 1. To reduce time to diagnosis of delirium. 2. For 100% of patients with delirium to have tailored interventions, including behaviour/ bowel/ food charts, medication reviews, and family involvement. 3. To increase junior doctors’ confidence in recognising and managing delirium.
Methods: Two changes were implemented and three cycles of data from inpatients on the geriatric wards were collected over an 8 week period. Qualitative data was also collected from doctors. The first change was teaching delivered to clinicians working in geriatrics. The second was implementing a new Delirium Bedside Bundle which was advertised in posters on the geriatrics wards.
Results: Data was collected from 60 inpatients, of whom 20 were diagnosed with delirium. The time to diagnosis was reduced from 3.5 days in cycle 1 to 1.6 days in cycle 3. There was an increase in documented medication reviews / cessation of sedating drugs from 0% in cycle 1 to 62.5% in cycle 3. There was an increase in family involvement from 60% in cycle 1 to 75% in cycle 3. Data collected from 19 junior doctors showed that confidence in caring for people with delirium increased from 57% to 92%.
Conclusion: Simple interventions such as teaching and implantation of an easy to use Bedside Bundle can positively impact recognition and management of delirium.