BMC Geriatrics (Sep 2024)

Improving delirium assessments in acute senior health: A quality improvement project for care of the older person

  • Charles Taylor,
  • Georgia Peakman,
  • Lauren Mackinnon,
  • Navid Mohamadzade,
  • Wayne Han,
  • Lucy Mackie,
  • Jasmine Gandhi,
  • Oliver Mitchell,
  • Caitlin Bateman-Champain,
  • Joseph Hetherington,
  • Fahed Belarbi,
  • Gaggandeep Alg

DOI
https://doi.org/10.1186/s12877-024-05273-x
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 11

Abstract

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Abstract Background Delirium is a common and reversible neurobehavioral condition with significant morbidity and mortality ramifications for older patients. Consequentially, clear guidelines exist pertaining to its swift identification and management. However, studies suggest that adherence to these guidelines are poor. This audit aimed to evaluate compliance to the National Institute for Health and Care Excellence’s (NICE) delirium guidelines in an Acute Senior Health Unit (ASHU) and to present a single centre experience of a low-cost ward-based intervention for improving delirium guideline adherence. Methods A retrospective observational audit was conducted on patients admitted to ASHU between 01/07/2023 and 30/07/2023. Data on delirium assessments, diagnoses and causes of delirium were obtained through retrospective database searches. Posters and education based multidisciplinary team (MDT) interventions were designed and initiated following grounded thematic literature analysis and ward discussion. A methodically equivalent audit was then conducted between 01/09/2023 and 30/09/23. Data was anonymised and blinded and analysis was performed on SPSS V12.0. Results A total of 128 patients were included in the study. Initial audit revealed suboptimal compliance with NICE recommendations. Chi-square test of independence found that patients were statistically more likely to receive a full delirium assessment (1.9% vs. 56.6%, p = 0.001) and formal diagnosis (5.8% vs. 27.6%, p = 0.002) after the ward-based intervention. Conclusion This study provides limited evidence in favour of low-cost MDT based interventions for improving adherence to NICE delirium guidelines and provides a 5-step framework for future studies. This study also explores the potential patient implications of these interventions. A repeat audit should be conducted to ensure lasting and sustainable change is achieved. Trial registration/clinical trial number AUDI003614.

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