Title : A closed audit loop on improving the adherence of delirium screening and effectiveness of the implementation of the single question of delirium (SQiD) as a screening tool
Introduction: Delirium affects up to 50% of the elderly who are admitted to in-patient facilities. Delirium is preventable in 30-40% of geriatric in-patients. Trust guidance recommends an initial screening for all admissions >65, followed by continuous monitoring. This initial screening is documented using the 4AT delirium assessment tool and documented as a proforma.
‘’Do you think the patient is more confused than before ?’’ is the single question in delirium (SQiD) rated positive or negative by clinical staff on reviews. Concept of SQiD is to facilitate a quicker and easy to use approach to screening delirium prior to longer delirium assessment for confirmation as appropriate. This project aims to improve the adherence to delirium screening in accordance with local trust guidelines in a geriatric ward in a tertiary hospital and record efficacy of implementation of SQiD.
Method: Baseline audit was conducted retrospectively from April to May to assess the adherence to trust guidelines. An educational poster to introduce SQiD and encourage filling of proformas. In addition, brochures and face to face interviews were conducted with the nurses to promote the usage of SQiD.
SQiD was incorporated into the nursing care rounds and usage recorded from June through July. The percentage of adherence to guidelines was prospectively analysed.
Results: Retrospectively, 9% of ward admissions had adhered to trust guidelines from months April to May. The introduction of SQiD significantly increased the filling of proformas to 88% from June through July. Number of SQiD documented increased from 0% to 89% into introducing the brochures and face to face interviews.
Conclusions: Although this project could be viewed as a success, the requirements for sustainability depend upon addressing limitations for completion of proformas and ongoing training. SQiD is not intended to replace tools such as CAM but seems to improve functionality and adherence in a routinely reviewed in-patient setting.
There will always be a trade-off between comprehensiveness and practicality with any screening test. Given SQiD’s ease of use and time efficiency, it serves good promise to improve recognition.