PPF11 Improving delirium assessment and management in hospice inpatient settings: findings from a mixed methods intervention development study

<h3>Background</h3> Delirium is a serious and distressing condition, which affects approximately 1 in 3 people admitted to hospice inpatient units (IPUs). We sought to develop and evaluate a multicomponent intervention to improve delirium care in hospice IPUs. <h3>Method</h3> We designed an intervention development study using convergent mixed methods. This involved an audit of patient case notes and an online questionnaire to multidisciplinary IPU staff. Drawing on these baseline findings and feedback from staff and public representatives, a multicomponent intervention was developed and implemented. Intervention components included brief ad-hoc onsite staff training, educational videos for staff and carers, a delirium education PowerPoint resource, and ongoing engagement with service managers. Following the intervention phase, the audit and questionnaire were repeated, and focus groups conducted with staff to explore findings. <h3>Results</h3> Screening for delirium using a validated tool (the 4AT) increased from 25% (n=25) at baseline, to 49% (n =49) after the intervention phase. The proportion of patients judged retrospectively as having delirium, who had the term ‘delirium’ documented in their case notes increased from 34% (n=10/29) to 58% (n=21/36). Fewer staff completed the questionnaire at follow-up (n=19 compared to n=45 at baseline); however, responses indicated improvements in self-reported understanding and management of delirium: 79% of respondents agreed they had received adequate training in delirium at follow-up, compared to 41% at baseline. Although improvements were noted, focus group discussion revealed that some nurses remained reluctant to use the term ‘delirium’ due to concerns about stigma, while others expressed uncertainty about diagnosing delirium. <h3>Conclusion</h3> A multicomponent intervention targeting hospice IPU staff was linked with improvements in delirium practice over a 12-month period. However, despite improvements, delirium documentation in case notes remained inconsistent at follow-up. Further initiatives are required to embed guidelines and evidence into routine practice.