Introduction
Delirium and acute confusion states are increasingly common in hospitalised older people, and are associated with significant morbidity and mortality. Despite this, delirium is often undetected or misdiagnosed when patients are admitted to hospital. The Care of Confused Hospitalised Persons program recommends undertaking delirium risk assessment using a standardised tool, in conjunction with cognitive screening, in patients aged over 70 years. This governing body directs local (Murrumbidgee Local Health District) and national (National Safety and Quality Health Services accreditation standards) standards for delirium risk assessment and management.
Aim
To determine the extent to which delirium risk screening in Wagga Wagga Base Hospital complies with local and national health guidelines for delirium screening, recognition and management.
Method/Description
A retrospective assessment of electronic medical records was performed using the Discern Analytics 2.0 program. Patients aged 70 years and over who were admitted to Wagga Wagga Base Hospital over a twelve day period were correlated, and filter was applied to determine whether a Delirium Risk Assessment Tool (DRAT) had been used at any time throughout a patient’s admission. In the presence of a DRAT, the record was again filtered to determine whether an Abbreviated Mental Test Score (AMTS) had been performed during the patient’s admission.
Results
A total of 130 electronic medical records across six wards were assessed. Overall, 71% of patients on Surgical wards and 66% of patients on Medical wards received a DRAT during their admission. Of these patients with delirium risk recorded, 69% of patients of the Surgical wards did not have a baseline AMTS performed, compared with 24% of patients in the Medical wards. The Orthopaedic ward had the highest overall compliance with delirium risk screening, at 82% of patients receiving a DRAT during their admission. The Stroke and Health Services Hub (HSH) wards both had the lowest compliance with DRAT at 62.5%.
Consclusions
Delirium risk screening and baseline cognitive screening is occurring in Wagga Wagga Base Hospital, however often the utility of delirium risk screening is limited when baseline cognition is not recorded. The reasons behind underperforming in assessment of both cognitive baseline and delirium risk are multiple, including clinician knowledge, time constraints and the ease of use of assessment tools. This indicates a need for ongoing clinical education around delirium risk screening and for a re-audit following this, in order to assess the impact of this intervention.