312 Paying attention to daily delirium screening in an acute hospital setting, an audit of implementation on orthopaedic wards

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Abstract Background Delirium is highly prevalent, yet two-thirds of cases remain undetected. Irish national guidance recommends daily delirium screening for all acute hospital in-patients at risk of delirium, including older patients. In this audit, we aimed to assess efficacy of implementation of a Delirium Care Bundle (DCB), incorporating delirium screening, risk factor assessment, and management, on two Orthopaedic wards. Methods Following a detailed feasibility assessment by a multidisciplinary group, the RADAR (Recognising Acute Delirium As part of your Routine) was chosen for daily delirium screening locally. This was incorporated into a DCB and an online training module was developed. Online training of staff was supplemented by in-person training on the wards. Three months post-implementation on two Orthopaedic wards, we audited DCB use. Additionally, we reviewed if patients were screened for delirium on admission (4AT) in the Emergency Department (ED), also recommended in national algorithms. Results Of 57 inpatients on the wards, eight were excluded (seven were too young to meet screening criteria; one was in theatre), leaving 49 patients eligible for audit. Seven (16.6%) patients had been screened in the ED at presentation. Thirty-five patients (71.4%) patient had the DCB commenced. Despite awareness, although the RADAR should be administered twice daily, we estimate that it was completed to 46% of target utilisations. Eleven (22.4%) patients had a positive RADAR at some point, four of whom had a negative 4AT screen in the emergency department. In those with a positive RADAR, documentation of consequent actions and preventative strategies was suboptimal. Conclusion The DCB was commenced appropriately in most patients. This audit identified that the RADAR use can be improved and that action steps following a positive screen were not being taken. Next steps include identifying barriers and facilitators to the use of the DCB and enhancing staff training in its use.

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