Nurses’ limited contribution to interdisciplinary delirium care of acute care patients following a positive 4AT: A medical record audit

Abstract

We sought to determine the extent and nature of interdisciplinary delirium care that hospitalised patients received following a positive delirium screen, and nurses’ contribution to that care. A Delirium Standard-aligned medical record audit involving patients with 4AT scores ≥1 in an Australian tertiary hospital, June - August 2024. Outcomes (overall and per Delirium Standard item, per item contribution by nurses) were analysed using descriptive statistics and frequency counts. No patient (N=100; median [IQR] age 83 [13.25] years) had all relevant Delirium Standard care documented, and adherence to Delirium Standard care varied across its aspects (4.5% -100%). Nurses documented almost all the positive delirium screens, administration of various treatments of delirium causes, and attendance to patient safety, but there was minimal documentation of their involvement in comprehensive assessment, patient centred information and support, or discharge planning. More active strategies than a Delirium Standard-aligned hospital guideline alone are needed to demonstrate patients with a positive delirium screen receive relevant follow-up care. Nurses working to the full scope of their practice may be one such strategy.