1050 DELIRIUM RECOGNITION AND MANAGEMENT IN AN INPATIENT REHABILITATION UNIT

Abstract

Abstract Introduction Delirium is associated with poor outcomes, but is under-diagnosed and under-treated. This project aimed to improve delirium recognition and multidisciplinary team (MDT) management on an inpatient rehabilitation ward. (NICE delirium: prevention, diagnosis and management, 2010). Methodology Using the Model for Improvement, the MDT identified four areas of delirium care; prevention, recognition, causes and management. Aspects of each were mapped in a driver diagram. The MDT voted on areas to target. Results and interventions were reviewed at weekly meetings. PDSA cycles 1.A delirium marker was introduced to the nursing handover and patients’ rooms. Data was collected on its use and weekly MDT meetings were used to check the accuracy of delirium identification. 2.An audit was completed of the 'patient profile’ information held in patients' bedside files. A person-centred ‘about me’ board was introduced instead and positioned visibly in patients’ rooms. 3.Healthcare assistants completed daily bowel charts. 4.Doctors completed anticholinergic medication reviews. Data was analysed using SPC charts. Results Before the delirium flag 0% of patients with delirium were identified on nursing handover. This improved to 58% on average, although some patients were incorrectly identified as delirious. Baseline personal profile completion rate was 61% on average, but the information quality collected was poor. The new ‘about me’ profile completion rate improved over time, varying between 16% and 86%. 100% of patients had medication reviews. Bowel chart completion improved from 89% to 100%. Conclusion Recognition of delirium improved. Stool charts and medication reviews were successfully implemented. The ‘about me’ board completion rate fluctuated but the information is now more visible. Our long-term goal is to improve patient-related outcomes such as engagement in therapy quality of life, and length of stay. Teaching sessions on delirium will be delivered by MDT members. Successful interventions will be expanded to other wards and PDSA cycles will continue.