Cooper, Conor

Handyside, Jeffrey

Henderson, Victoria

Hunter, Alexandra

Scott, Derek Anthony

English

Aberdeen University Research

Easy as 4-AT:  Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational InterventionConor Cooper1, Alexandra Hunter2, Jeffrey Handyside3, Dr Derek Scott4, Dr Victoria Henderson51 School of Medicine, Medical Sciences & Nutrition, University of Aberdeen 2Dr Gray’s Hospital, Elgin Background•Delirium is a common and serious complication of acute illness•The condition remains poorly diagnosed in older patients •The 4-AT is a simple way to screen for delirium and should be used on all acute admissions aged 65 and over•HIS inspection (2017) revealed issues with adherence with this protocol at Dr Gray’s hospital, Elgin•Several other institutions have reported poor adherence to delirium screening tools Aims•To assess 4-AT protocol adherence in the ACE unit •To identify attitudes and potential barriers influencing adherence •To design and implement an educational intervention to improve 4-AT protocol adherence  • Medical and nursing notes of inpatients on the ACE unit >65 years were reviewed for 4-AT staff adherenceCase note review:  1st cycle (15/01/18)• A 10 question online survey was conducted to assess junior doctors’ perspectives on the 4-AT• Survey was sent to all  junior doctors in Dr Gray’s via an email linkSurvey• Based on survey feedback, a video demonstration was designed with a specific focus on how to assess acute change in cognition (component 4 of 4-AT)• Clarified the external sources that can be used to fully complete the 4-AT• Video was shown during an FY1 teaching session (14/03/18)• Feedback surveys were immediately disseminated to the attending junior doctors following the teaching sessionIntervention• Two days following the intervention, medical and nursing notes of inpatients on the ACE unit >65 years were reviewed for 4-AT adherenceCase note review:  2nd cycle (16/03/18)MethodResults• Pre-intervention:  of the eligible notes reviewed (n=26), staff adherence to 4-AT guidelines was 57.7%• The survey identified several emerging themes which pose as potential barriers to staff 4-AT adherence:• Specifically, the feedback highlighted that there were deficits in staff ability to assess “acute change” (the 4th component of the 4-AT)• Post-intervention:  ofthe eligible notes reviewed (n=23), adherence to 4-AT guidelines was 60.9%.• There was no significant increase (p=0.821)following the intervention• The majority of staffagreed that the video intervention made them feel more confident in assessing for ‘acute change’ in a patientLack of agreement in 4-AT guidelinesLack of education on 4-ATUnavailability of assessment form Challenging patient behaviour57.70% 60.90%42.30% 39.10%1st cycle (15/01/18) Re-audit (16/03/18)Conclusion •There were clear deficits in staff adherence to 4-AT protocol, supporting the findings of the HIS inspection report•Barriers to adherence included lack of education, with a specific weakness in the ability to assess for acute change•The intervention proved to be of limited effect in improving overall adherence, however it showed effect in addressing the issue of acute change assessment Not adherent to 4-AT protocolAdherent to    4-AT protocolAgree56%Disagree44%Recommendations • Enhance teaching to stress the value of the 4-AT and the serious implications of undetected delirium• Incorporation of 4-AT reminder stickers on all eligible case notes• Uniformity in storage of 4-AT forms across wards• Implementation of an ongoing audit and feedback cycle, targeting the issue of 4-AT staff adherence in Dr Gray’s

Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention

https://aura.abdn.ac.uk/bitstream/2164/11400/1/Cooper_et_al_4AT_poster_BGS_Nov_1_2018.pdf

Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention

Abstract

Similar works

Full text

Available Versions

Aberdeen University Research