Improving Delirium Screening and Management in Hospitalized Older Adults with the 4AT
| dc.contributor.advisor | O'Neal, Madelyn | |
| dc.contributor.author | Poon, Michelle M. | |
| dc.date.accessioned | 2025-06-04T12:53:43Z | |
| dc.date.available | 2025-06-04T12:53:43Z | |
| dc.date.issued | 2025-05 | |
| dc.description.abstract | Problem: Delirium in hospitalized older adults is associated with prolonged hospital stays and an increased risk of complications. In a three month period, 60% of patients 65 years or older admitted to a 24-bed medical-surgical unit in a medium-sized community hospital had at least one error in orientation which predisposed them to delirium. Nurse-driven delirium screening did not routinely occur for non-intensive care patients. Gaps in standardized screening raised concern for possible under-recognition of delirium and posed a safety risk to older adults in this setting. Purpose: The purpose of this quality improvement project (QI) was to improve delirium screening and management among hospitalized adults 65 years and older by measuring adherence to the 4AT tool and subsequent nurse-driven delirium interventions, an evidence-based practice change, over 15 weeks. Methods: Nurses screened patients on admission and once a shift for delirium with the 4AT tool. Nurses notified the provider, completed an attestation, and documented nonpharmacologic delirium interventions in the EHR for patients with abnormal 4AT scores. Data was collected through weekly chart audits and blind audits of patients’ rooms and electronically disseminated to stakeholders to assess adherence and identify areas of improvement. Results: 493 patients 65 years and older were admitted to the unit and 71% (n = 352) were screened for delirium with the 4AT tool. 7% of patients (n = 26) had abnormal 4AT scores. Providers were notified 38% (n = 10) of the time and delirium attestations and interventions were initiated 100% (n = 26) of the time for abnormal 4AT scores. Conclusions: The 4AT tool is feasible in identifying and managing patients at risk for delirium. Compliance rates and provider notification did not meet the 100% goal and indicate a need for further investigation. Early initiation of delirium interventions can reduce the incidence of delirium and improve patient safety outcomes. | |
| dc.identifier.uri | https://archive.hshsl.umaryland.edu/handle/10713/23676 | |
| dc.language.iso | en_US | |
| dc.subject.mesh | Delirium | |
| dc.subject.mesh | Mental Status and Dementia Tests | |
| dc.subject.mesh | Mass Screening | |
| dc.subject.mesh | Health Screening | |
| dc.subject.mesh | Aged | |
| dc.subject.mesh | Quality Improvement | |
| dc.title | Improving Delirium Screening and Management in Hospitalized Older Adults with the 4AT | |
| dc.type | DNP Project |