3094 Delirium assessment and management in health care for older people wards at Good Hope Hospital: a quality improvement project

Abstract

Introduction Delirium is a common presentation in geriatric medicine. Improvement in delirium assessment and management should improve identification of these patients and improve their outcomes. This Quality Improvement Project, completed by a group of Health Care for Older People (HCOP) resident doctors, aimed to improve delirium assessment and management for patients admitted to the five HCOP wards at Good Hope Hospital, Sutton Coldfield. Methods Patients with documented confusion were selected and delirium assessment/management was compared to current NICE Guidance. This included whether delirium screening was done, which screening tool was used, and how delirium was managed. Data was collected retrospectively from electronic patient records, anonymised, and recorded using an online form. Data from 85 randomly selected patients admitted to HCOP wards in Good Hope Hospital during September 2024 was collected. Interventions of departmental teaching for all HCOP doctors and informative posters in common areas were implemented. Data collection was then repeated with 77 patients admitted during November 2024. Results Screening for delirium increased from 55.3% to 71.4% (+16.1%). Use of the NICE recommended 4AT tool increased from 30% to 43.9% (+13.9%). Implementation of non-pharmacological techniques (such as re-orientation) rose from 2.4% to 16.9% (+14.5%), and treating an identified cause rose from 75.6% to 94.8% (+19.2%). Conclusion Departmental teaching and educational posters were successful in improving delirium assessment and management. The largest improvements were in using a screening tool and treating an identified cause, which are largely undertaken by doctors. To improve further, educational efforts could be extended to the entire multi-disciplinary team. This may have resulted in more frequent use of non-pharmacological interventions. To implement long-lasting change, the posters have been provided to the department and delirium will continue to be taught in departmental teaching for future rotations of resident doctors.