Abstract
Background: Delirium is a fluctuant clinical syndrome caused by an underlying condition not better explained by a pre-existing neurocognitive disorder. Clinical presentation is characterised by alterations in attention, cognition and consciousness. It is categorised into hyperactivity and hypoactivity based on behaviours displayed. 25% of elderly patients are diagnosed with a delirium on admission to hospital. Delirium is associated with a 70% mortality rate 6 months post discharge. R.A.D.A.R is a 3 part questionnaire recommended by NICE to use as a daily screening tool to aid early diagnosis of delirium.
Aims: Initiating mandatory use of R.A.D.A.R questionnaire during nursing drug rounds to increase early detection of delirium during inpatient COTE admissions.
Methods: R.A.D.A.R questionnaires were completed by nursing staff during daily drug rounds for four weeks.Patients scoring 1 or above were screened using 4AT and referred to dementia and delirium outreach team (DDOT) as appropriate.Data collected was analysed to assess sensitivity of R.A.D.A.R in detection of acute delirium.
Results:R.A.D.A.R proved sensitive detecting delirium and/or known cognitive impairment recognising 35 patients known to DDOT. It highlighted 7 patients at end of life or with advanced dementia. R.A.D.A.R identified 8 new diagnoses of acute hypoactive delirium over a 4 week period.
Conclusion: Initial detection of delirium, completion of 4AT and referral to DDOT is done well. Reassessing patients throughout their admission could be improved. We recommend using R.A.D.A.R as a mandatory part of nursing evaluation as it has proved sensitive and efficient in detection of new delirium.