LAUSR

Background: A diagnosis of delirium among older inpatients is associated with increased length of stay, morbidity and mortality. Recognition of delirium in hospitals is poor leading to underdiagnosis and mismanagement. The National Clinical Programme for the Older Person (NCPOP) has published a pathway for the assessment and management of delirium in older people. Our objective was to assess the point-prevalence of delirium in all >/=65 year old inpatients with a hip fracture in our institution on the 27/07/2016. Parallel to this we assessed if patients were managed according to NCPOP guidelines. Methods: All inpatients >/= 65 with a diagnosis of hip fracture were screened for delirium using the 4AT and the AMTS (Abbreviated-Mental-Test-Score). Medical notes were reviewed to assess if delirium management was according to guidelines. Results: 16 inpatients were included, mean age 82.94 yrs. 50% screened positive for delirium. 9 patients had an underling diagnosis of dementia. The mean score of the 4AT 3.31, 3 patients scored 0. 6 patients scored ≥4, suggestive of delirium. The mean score of the AMTS was 6.25. 9 patients had a score ≤7, indicating evidence of possible cognitive impairment +/− delirium. For the 8 patients with a documented diagnosis of delirium, 6 received pharmacological intervention: quetiapine as first line (4 patients), haloperidol (1 patient), and haloperidol & quetiapine (1 patient). 7 patients also received non-pharmacological therapies; relocation to a single room (2 patients), healthcare assistant supervision (2 patients), falls alarm and falls mattress (4 patients), orientation measures (clock & calendar 5 patients). Conclusion: The point prevalence of delirium in our patient cohort was high. Patients were being screened for delirium; however, screening tools employed were not documented. First line medications used were not according to guidelines. Delirium care is therefore suboptimal. Going forwardthe NCPOP pathway has been deployed on the orthopaedic ward and formal education about the guideline given to HCPs. After 6 months we will re-audit.