675 IMPROVING RECOGNITION OF DELIRIUM IN CRITICAL CARE PATIENTS

Abstract

Abstract Introduction Delirium is more prevalent in patients admitted to the critical care environment, those over 65 years old and living with frailty. By increasing the recognition of delirium we can improve management of patients and therefore reduce associated morbidity. Initial audit of this patient group highlighted that we are missing opportunities to screen for, diagnose and document the presence of delirium. This Quality Improvement project aimed to improve delirium screening, and therefore recognition, on the critical care unit at The Royal Bolton Hospital. Method A retrospective analysis of patients aged ≥65 years or with a CFS ≥5 admitted to critical care at The Royal Bolton Hospital over a 2-week period for each PDSA cycle. Three cycles were undertaken. The initial intervention was a local teaching session for medical and nursing staff on critical care. The second intervention was to display delirium information posters throughout critical care which encouraged recognition and screening of delirium. Results Prior to intervention 9% of this patient group were assessed for delirium on admission to critical care and 55% were re-assessed at some point during their admission. After the initial intervention these numbers significantly improved to 33% and 80% respectively. After the second intervention 8% were screened on admission and 69% were re-assessed. Missed opportunities to document delirium as a diagnosis remained similar throughout all cycles. Conclusion We can improve delirium screening via regular educational sessions for medical and nursing staff on critical care. Information posters do not appear to have as much impact. There is scope to improve documentation of delirium as a diagnosis which would further aid in management and outcomes. We suggest a further PDSA cycle with an intervention to address this.