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delirium, prevention, quality improvement, management, screening



  1. Hamilton, Wendy DNP, APRN, AGCNS-BC, RN-BC
  2. O'Neel, Nicholas DNP, ARNP, AGCNS-BC, CMSRN
  3. Lacuzong, Mariana MSN, APRN, AGACNP-B C, ACCNS-AG, CCRN
  4. Lazarus, Ann Marie MSN, APRN, AGCNS-BC
  5. Johnson, Peter MD
  6. Gupta, Amit MD


Purpose/Objectives: The purpose of this quality improvement initiative was to implement delirium screening, prevention, and management best practices in the non-critical care environment.


Description of the Project/Program: An interprofessional team at a 483-bed level 1 trauma center implemented a quality improvement initiative on one 24-bed medical ward and one 24-bed surgical ward. The 4 A's Test (4AT) screening tool was administered to patients with risk factors for delirium on admission, every shift, and as needed by nursing staff. Evidence-based prevention and management order sets were created by an interprofessional team to guide patient care planning processes.


Results: A total of 285 patients who were at high risk for delirium (100%) were screened using the 4AT tool. Forty-three of the 285 patients (15%) were positive on the 4AT screening or diagnosed with delirium, whereas 242 patients (85%) had a negative score on the 4AT. Delirium detection increased from 2.1% to 15% after implementing the 4AT. Fifty-six (19%) of the 285 high-risk patients had prevention order sets placed. Of the 43 patients who scored positive, 2 charts had management order sets placed.


Conclusion: A validated delirium screening tool and intervention order sets can increase early detection rates and provide staff with tools to prevent and manage delirium. The impact of this project will likely reduce preventable harm to patients and improve the quality of care that staff are able to provide in the medical-surgical acute care setting.