A quality improvement project to prevent, detect, and reduce delirium in an acute setting

Objective: To implement a best practice approach to assessment, management and prevention of delirium in two acute medical wards. Design: Twelve month quality improvement project using local data to develop and implement local guidelines and tools. Setting: Two acute medical wards in a tertiary hospital.: Subjects: Ward staff and stakeholders. Interventions Delirium screening tool, local clinical pathway, educational program, standardised nursing care plan, practical resource 'rummage' boxes, and a carer information pamphlet. Main outcome measures Ward audit, focus groups and staff perception survey. Results: Delirium was found in ten patients among a total of thirty participants (prevalence of 37%) but only half of these cases were diagnosed by the ward medical team. Confusion was noted by nursing staff in all cases of delirium. Almost all of the participants (29/30) had three or more risk factors for delirium and thus were at high risk. Focus group participants were knowledgeable about delirium, but felt that resources and support were limited. Project tools used were acceptable to ward staff (participants of focus groups); however, substantial numbers of staff remained unaware of the project materials. Conclusion: A global approach to prevention in high risk hospital populations may be needed. Nursing staff are well placed to screen for delirium, however, sustaining change is challenging.