40SCREENING FOR COGNITIVE IMPAIRMENT IN PATIENTS OVER 65 YEARS OLD BY USING COGNITIVE SCREENING TOOLS SUCH AS ABBREVIATED MENTAL TEST SCORE (AMTS) FOR EARLY DIAGNOSIS AND MANAGEMENT OF DELIRIUM

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Abstract

Evidence-base: As per Royal College of Physicians national guidelines, delirium affects up to 30% of older patients admitted to hospital. Patients with delirium have high mortality (6-18%), institutionalisation and complication rates as well as increased length of hospital stay. Recent evidence demonstrates that improved understanding of delirium by early diagnosis using AMTS screening tool and attention to at-risk patients can both prevent the onset of delirium and reduce future episodes.

Change strategies: Audits were carried out in 3 cycles (first, second in 2010, and third in 2012). These looked onto the completion rates of AMTS on 1st clerking of medical and trauma patients. In the interval between the first two audit cycles, local change strategies included educational meetings at both departmental and hospital-wide levels, emails, posters, AMTS stickers and red marker circling on medical admission booklet. After second cycle a new medical booklet was introduced highlighting use of AMTS in over 65 year olds.

Change effects: In first audit cycle in 2010 retrospective case note reviews of 83 patients 65 years or older found AMTS completion at54%, Of these 60% were completed by house officers.64% of these patients were reviewed by geriatrician consultant in post take ward round. The second audit cycle found marked improvement, with 75% AMTS completion by all grades of doctors and no difference between Geriatricians and General Physicians. In the third audit cycle with the new admission booklet 78% patients had AMTS completed on admission with no variation in grade of doctors and speciality.

Conclusion: The development of new admission booklet with highlighted AMTS together with improved education concerning early diagnosis of delirium and identifying at risk patients over the past years have led to more awareness and better detection of cognitive impairment. We postulate that this will translate into improved patient outcomes by early management of delirium.

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