TIME to think about delirium: improving detection and management on the acute medical unit.

BMJ Open Quality
Yehudit BauernfreundElizabeth L Sampson

Abstract

Delirium affects 18%-35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients and their families. We used quality improvement tools and a multicomponent intervention to promote detection and improve management of delirium on the acute medical unit (AMU). We reviewed whether a delirium screening tool (4AT) had been completed for all patients aged over 65 years admitted to the AMU over 1 week. If delirium was detected, we assessed whether investigation and management was adequate as per national guidance. After baseline data collection, we delivered focused sessions of delirium education for doctors and nursing staff, including training on use of the 4AT tool and the TIME (Triggers, Investigate, Manage, Engage) management bundle. We introduced TIME checklists, an online delirium order set and created a bedside orientation tool. We collected data following the interventions and identified areas for further improvement. Following our first PDSA (Plan, Do, Study, Act) cycle, use of the 4AT screening tool improved fr...Continue Reading

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Citations

Apr 17, 2020·European Geriatric Medicine·Emma R L C Vardy, Rebecca E Thompson
Aug 6, 2019·Aging Clinical and Experimental Research·Irene MansuttiUNKNOWN ESAMED team
Dec 29, 2020·The British Journal of Oral & Maxillofacial Surgery·J E CrawfordJ McMahon
Nov 14, 2020·Nature Reviews. Disease Primers·Jo Ellen WilsonE Wesley Ely
Nov 17, 2020·Geriatric Nursing·Laurence M SolbergRonald Shorr
Aug 5, 2021·JMIR Formative Research·Guruprasad D JambaulikarPeter Ray Chai

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Software Mentioned

PDSA
4AT

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