Introduction The Centre for Perioperative Care recommends the assessment and documentation of delirium using a validated tool such as the 4-AT in older people undergoing surgery. Aim This quality improvement project (QIP) aimed to improve the assessment and documentation of delirium in patients aged 65 and above following vascular surgery in a tertiary centre. Methods Patients aged ≥65 years who had undergone vascular surgery were identified and data was collected with access to the electronic patient record system. Analysis was carried out using Microsoft Excel and SPSS. Following baseline measurements taken in August 2023, 1 plan-do-study-act (PDSA) cycle was completed between September 2023–January 2024. Baseline measures Baseline data collected between August 1-31st 2023 identified 51 patients, of which delirium was screened using the 4-AT tool in 39.2% (n = 20), on average 90 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review (100%, n = 51). There were clinical concerns of post-operative delirium documented in 7 patients, with the 4-AT documented in 5 of those cases. Intervention Interventions included stakeholder discussions to identify key barriers in the assessment and documentation of delirium, multidisciplinary team education and poster reminders across the ward. These were introduced between November–December 2023. Results Post-intervention results reviewed between 10th-31st January 2024 showed that the 4-AT was used to screen for delirium in 61.9% of patients (n = 13), on average 45 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review. In addition, 2 patients developed delirium post-operatively with the 4-AT reported in both cases. Conclusions This QIP has demonstrated a marked improvement in compliance with national guidelines on the assessment of delirium, highlighting the impact of multidisciplinary education in improving the perioperative clinical pathway for older people undergoing surgery. Future PDSA cycles will focus on improving the documentation of 4AT in the post-operative surgical review.

中文翻译：

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2354 接受血管手术的老年患者谵妄的临床评估和记录：质量改进项目


引言 围手术期护理中心建议使用经过验证的工具（如 4-AT）对接受手术的老年人评估和记录谵妄。目的 该质量改进项目 （QIP） 旨在改进 65 岁及以上患者在三级中心接受血管手术后谵妄的评估和记录。方法 确定年龄≥ 65 岁接受过血管手术的患者，并通过访问电子病历系统收集数据。使用 Microsoft Excel 和 SPSS 进行分析。根据 2023 年 8 月进行的基线测量，在 2023 年 9 月至 2024 年 1 月期间完成了 1 个计划-执行-研究-行动 （PDSA） 周期。基线测量 2023 年 8 月 1 日至 31 日期间收集的基线数据确定了 51 名患者，其中 39.2% （n = 20） 的患者在术后平均 90 小时内使用 4-AT 工具筛查了谵妄。4-AT 从未记录在顾问主导的外科术后审查中 （100%，n = 51）。7 例患者有术后谵妄的临床担忧，其中 5 例记录了 4-AT。干预 干预措施包括利益相关者讨论以确定谵妄评估和记录中的主要障碍、多学科团队教育和整个病房的海报提醒。这些是在 2023 年 11 月至 12 月期间推出的。结果 2024 年 1 月 10 日至 31 日期间回顾的干预后结果显示，4-AT 用于筛查 61.9% 的患者 （n = 13），平均术后 45 小时。4-AT 从未记录在顾问主导的外科术后审查中。此外，2 例患者术后出现谵妄，两例均报告 4-AT。 结论该 QIP 在遵守国家谵妄评估指南方面有显着改善，突出了多学科教育在改善接受手术的老年人围手术期临床路径方面的影响。未来的 PDSA 周期将侧重于改进术后手术审查中 4AT 的记录。