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Think Delirium Scottish Delirium Association Pathway Overview & Sharing Good Practice Linda Wolff Mike Hendrix, NHS Forth Valley.

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Presentation on theme: "Think Delirium Scottish Delirium Association Pathway Overview & Sharing Good Practice Linda Wolff Mike Hendrix, NHS Forth Valley."— Presentation transcript:

1 Think Delirium Scottish Delirium Association Pathway Overview & Sharing Good Practice Linda Wolff Mike Hendrix, NHS Forth Valley

2 Experience in Forth valley orthopoedic unit Linda Wolff Mike Hendrix Improving detection and Management of delirium in hip fracture

3 Outline Where are we now? Where do we want to be? How are we trying to get there?

4 Why Bother? National Priority Delirium present in up to 60% patients over 65 with hip fracture 3 rd busiest ortho unit in Scotland 380 hip fracture patients/ year Pressure on beds Staffing challenges

5 Delirium Outcomes Delirium present in up to 60% patients Length of stay x 3 40% mortality High morbidity Stress

6 Patients and carers say… Said he was being difficult Said she has dementia They didn’t explain Took her food away Too much medication I was so worried

7 Where do we want to be? Reliable recognition and management of delirium in patients with hip fracture

8 How are we trying to get there? Steering group Questionnaires- staff Patient stories Identification of delirium Develop management protocol

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10 Protocol AMT 10 CAM Medical Pain Management Nursing Discharge

11 Tests of change

12 Training All nursing staff Hospital Delirium Study Days Presentations to ortho surgeons

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14 AMT 10 Who will do it ? Junior docs, staff nurse, ANPs Audit Flow chart Screen saver

15 Think Delirium!

16 Untreated delirium can increase length of stay up to 3 times

17 Think Delirium!

18 Any one of these can cause delirium: Infection Infection Fracture Fracture Pain Pain Mental stress Mental stress Constipation Constipation Dehydration Dehydration Low oxygen levels Low oxygen levels Morphine Morphine

19 How are we doing?

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21 Delirium Bundle CAM Done 1L fluid in first 24 hours Abbey pain score Di-hydrocodeine prescribed Up to sit within 24 hours Delirium documented Discharge letter All or nothing

22 Bundle data July % had AMT, 83% <9/10 30% had CAM 60% fluid >1L No Abbey Pain scores 100% analgesia compliance 60% up to sit in 24 hours NO documentation in letter

23 Sprint Audit pts 66% AMT10 62% of those had AMT <9 9/10 had a CAM performed 33% of those CAM +ve AWI challenges

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25 Successes Improved cognitive assessment Improved staff knowledge More consistent pain management Increased documentation of delirium Introduction of butterfly scheme Carer’s letter to CE Mike feel free to add…

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27 Challenges Cognitive assessment / detection Delirium Bundle just starting AWI irregularities Engage all medical staff Evaluation LOS, complaints, questionnaires, discharge documentation

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