160 Improving the recognition of delirium in palliative care patients in a hospice setting by employing the validated screening test ‘4AT’ on admission clerking: a quality improvement project

<h3>Background</h3> According to the National Institute of Health and Care excellence (NICE) guidelines, a large proportion of palliative care patients are at high risk of delirium. Relying on clinical suspicion for the recognition of delirium alone risks the condition going undiagnosed and therefore unmanaged, hence formal screening is recommended. A recent study has validated the use of the 4AT screening tool in terminally ill patients and found evidence to support its use for the detection of delirium on hospice admission. <h3>Aim</h3> The primary aim was to improve the initial recognition of delirium through increasing the percentage of patients undergoing 4AT screening on admission to the Macmillan Unit hospice (MMU). <h3>Methods</h3> Data was collected from online admission documentation looking at patient demographics, whether any delirium screening was undertaken and whether confusion was mentioned. Data collection took place prior to, and following, the implementation of the intervention which involved adjusting the clerking proforma to include a 4AT score. <h3>Results</h3> From the 20 patients admitted to MMU from the 20/06/2024 to 02/07/2024, zero had any formal confusion screening and seven had mentions of confusion documented. From the 20 patients admitted from the 18/07/2024 to 03/08/2024 following the intervention, eleven had formal confusion screening and six had mentions of confusion documented. The data shows a 55% increase in the number of patients being screened for delirium on admission to MMU. <h3>Conclusions</h3> The intervention was effective in increasing the percentage of patients who underwent delirium screening on hospice admission. Acknowledged limitations included not all clerking staff being aware of how to use the 4AT appropriately, including appreciating its clinical significance. Increasing the wider MDT’s understanding of the 4AT scoring system will likely further improve the early recognition and treatment of delirium. Further work is indicated to document the impact of this successful intervention.