Development and pilot evaluation of ACE-T, a nurse-focused delirium initial-response tool, across three health systems

Background A positive delirium screen should trigger timely assessment and care, but the initial bedside response is not always clearly defined. ACE-T (Acute Triggers / Patient Experience / Treatments) is a nurse-led tool (www.theace-t.com) that sets out initial care actions and supports documentation and team communication. Objectives To assess perceived usability and utility, refine the tool, and describe documentation before and after its introduction at three hospitals. Methods In this developmental pilot, 53 multidisciplinary staff completed a structured survey and provided free-text feedback. We also reviewed a non-random sample of 60 records: 10 before and 10 after ACE-T introduction at each site. Prespecified delirium-care actions documented within 48 hours of the first positive delirium screen or documented diagnosis were summarised descriptively by site. Results ACE-T was rated easy or very easy to use by 75% (39/52), clear or very clear by 77% (41/53), and very or extremely helpful for improving delirium care by 71% (37/52). Feedback guided revisions to clarify professional roles, fit clinical workflows and strengthen person-centred prompts. Documentation of delirium or suspected delirium was more frequent after introduction at all three sites: 1/10 before versus 10/10 after in Germany, 0/10 versus 10/10 in the UK, and 3/10 versus 9/10 in the USA. Changes in documentation of other assessments varied by site. Conclusion ACE-T is a promising nurse-led tool for initial delirium care. Positive staff ratings and more frequent delirium documentation support its further development and prospective evaluation. It offers nurses a practical starting point for what to do next when delirium is detected.