128 THE USE OF THE IRISH NATIONAL EARLY WARNING SCORE TO DOCUMENT NEW CONFUSION

Abstract

Abstract Background The Irish National Early Warning System (INEWS) V2 has added ‘new confusion/altered mental status/delirium’ as a sign of early deterioration. It is captured as ‘C’ in ACVPU. A ‘C’ score’ should prompt concern regarding possible serious causes and requires urgent clinical review. The objective of this study is to identify the extent to which the INEWS ‘C’ score is used appropriately by healthcare professionals in an Irish hospital. Methods This is a cross-sectional study of inpatients over 65 years. Medical records, nursing notes and INEWS charts were reviewed for documentation of ‘new confusion’ during admission. The 4AT, which is a rapid delirium screening tool, was completed on the day of the audit for further confirmation. Descriptive statistics are presented. Results 20 patients were included, 65% were male, mean age 80 years. 95% of patients had been inpatients for >10 days. No patients had an INEWS ‘C’ score documented in their INEWS chart during admission. ‘New confusion’ was documented in 45% of patients’ nursing notes and 15% of patients’ medical notes. Delirium screening was completed on 45% of patients. On the day of data collection, 65% of patients had a 4AT score greater or equal to 1, and 15% of patients had a score of 4. Conclusion Over half the patients reviewed in this study had ‘new confusion’ documented in their medical records or nursing notes during their admission, however, this was never captured on the INEWS chart. Furthermore, 65% of patients had a 4AT score greater than or equal to one on the day of the audit. This study highlights the need for ongoing training, behavioural change and a cultural shift by health care professionals and organisations to ensure adherence with INEWS ‘C’ score and related escalation protocols.