Abstract
1. Introduction
Delirium is a very common and treatable condition, and approximately 20-30% of older patients in medical wards in hospitals presented with delirium. Hence it is important to do timely assessment and correct management of delirium. This QIP was carried out to improve adherence to the trust’s clinical guideline for delirium and to improve the communication with patients, relatives, and primary care doctors.
2. Method
40 patients’ notes were randomly reviewed in the geriatric wards of the Addenbrooke’s hospital as baseline, then 20 patients’ notes were reviewed again after PDSA intervention. As an intervention, we introduced new discharge template to ensure better communication with the GP and we did departmental teaching session to promote awareness of delirium assessment and management. Patients on End-of-Life care were excluded.
3. Results
Compliance of delirium screening tests (4AT or CAM) markedly increased from 37.5% to 80% and documentation of delirium diagnosis in the discharge letter was improved from 70% to 100%. Doing cognitive assessment increased from 32.5% to 40% while performing confusion screening bloods raised from 57.5% to 75% and CXR from 85% to 90%. Taking collateral history was noted to be less complied with 75% after intervention from 85%. Performing urine culture/analysis dropped from 55% to 20%. Assessing delirium screening tool within 24 hours of admission, documenting delirium trigger factors and updating delirium in the problem lists were also analysed.
4. Conclusion
This QIP has shown improvement in delirium assessment and management, but some areas were identified for further progress. It is recommended to continue promoting awareness of delirium (diagnosis, assessment, investigations, and discharge letter template) within department.