Implementing a Delirium Assessment Tool to Increase Routine Assessment for Hospice Patients

Background: Hospice care focuses on palliation for individuals in the last six months of life. Delirium is highly prevalent in this population and negatively impacts hospice patients, families, and clinicians. Delirium is often unrecognized, and research has shown that routine assessment can increase delirium identification and improve care outcomes. Purpose: To implement a delirium assessment tool in a hospice setting with aims to increase routine delirium assessment, nursing knowledge, and family education. Methods: The PDSA cycle guided this quality improvement project. In-patient hospice nurses completed a survey assessing delirium knowledge, beliefs, and practices. Delirium education was provided, and the nurses were asked to use the 4AT for routine assessment, once per shift. The nurses were asked to provide family education for patients with a positive delirium score and document interventions. The nurse survey was repeated after implementation to assess changes in delirium knowledge and practice. Results: Routine assessments were completed 6% of the time. 90% of the patients assessed were positive for delirium. The completion rate for family education was 23%. Nurses used non-pharmacological interventions alone 41% of the time and pharmacologic interventions alone 7% of the time. Recommendations and Conclusion: This data supported the high prevalence of delirium among hospice patients. However, the hospice nurses did not find value in using the 4AT tool in the in-patient setting, and they were reluctant to provide delirium education with families. Comprehensive delirium education and adequate staff resources are needed to successfully incorporate a structured assessment process into routine practice.Key Words: Delirium, hospice, terminal, end of life, palliative care, prevalence, incidence, screening, assessment, diagnosis, impact, effects, consequences, treatment, intervention, therapy, management, and cost