Delirium in Older Inpatients: Prevalence and audit of adherence to hospital guidelines for screening and management

Abstract Background Delirium is one of the most common complications of hospitalisation in older people. A 2020 review estimated an inpatient rate of 23%. In 2017, the INEWS2 was updated to include ‘new confusion’ as part of the disability section (ACVPU). Our hospital included a section on INEWS2 to record 4AT for patients with ‘new confusion’ and a prompt to the delirium guidelines. The aim of our study was to document delirium prevalence in patients admitted under our service and adherence to hospital delirium screening (recording ‘new confusion’ on INEWS2 and 4AT) and management guidelines. Methods A retrospective chart review was conducted of all patients admitted under the geriatric teams during a one-week period. Delirium prevalence was determined by chart review and talking to the medical team. INEWS2 charts were reviewed to determine whether ‘new confusion’ was recorded in the ACVPU section and if a 4AT was completed. For patients with delirium, adherence to the hospital guidelines was determined by chart review. Results We included 78 patients ; 55% were female with a median age of 86.5 years (range 63-99). Thirty-seven patients (47%) were diagnosed with delirium. Only 7 (19%) of these had ‘new confusion’ documented on the INEWS2 chart; 3 (8%) had a 4AT documented. The sensitivity of INEWS2 for delirium detection was 19%; specificity 100%. The hospital delirium management guidelines were followed for all patients. Conclusion We found that almost 1 in 2 older patients admitted under our geriatric medicine service experience delirium. Despite excellent adherence to our delirium management guidelines we found low rates of screening for delirium. The INEWS2 ‘new confusion’ has low sensitivity but high specificity for delirium detection; 4AT’s are rarely documented. Further education of nursing and medical staff is required to ensure that daily screening for delirium occurs to enable rapid identification when it occurs.