Authors (including presenting author) :
Chan HCM (1), Wong CP (1), Fong HY (1), Wong HL (2), Ng MW (2), Yuen CM (2), Cheung SMC (1), Tam YY (3)
Affiliation :
(1) Department of Medicine, Tseung Kwan O Hospital
(2) Department of Medicine, Haven of Hope Hospital
(3) Nursing Services Department, Kowloon East Cluster
Keyword 2: :
Nurse screening
Keyword 3: :
Inpatient monitoring
Introduction :
To address the high prevalence of delirium in acute ward and significant adverse outcomes in the elderly population, early detection and regular monitoring should be adopted alongside a comprehensive care bundle to enhance delirium care in hospitals. Ward nurses fulfill the pivotal duty of identifying delirium, exploring relevant risk factors, monitoring the condition, and executing delirium-specific interventions. However, there is no existing framework for nurse-led screening and monitoring for the elderly in delirium in acute clinical setting.
Objectives :
This study aims to examine the effectiveness of the nurse-led screening of Delirium in acute medical wards and to explore nurses’ knowledge and attitude towards these enhancement measures in delirium care for hospitalized elderly.
Methodology :
Aged 65+ patients with a preliminary diagnosis of decreased general condition, confusion, delirium, or suspected delirium, were recruited in three acute medical wards in Tseung Kwan O Hospital from April to May 2025. Ward nurses performed delirium screening using the Short Confusion Assessment Method (Short-CAM) proactively. For each positive case, risk factor identification was proceeded with corresponding interventions. The patient’s delirious state was continuously monitored through orientation and attention span assessments. Delirium-specific intervention cue cards were attached to the hospital Kardex. Clinical data and pre- & post-test questionnaires from staff were analyzed while the paired sample t-test was applied to analyze statistical significance.
Result & Outcome :
A total of 35 patients were recruited. Among the 21 patients screened positive, 16 patients (76.2%) were diagnosed with delirium by a doctor. Electrolyte disturbance, infections, iatrogenesis (including restraint application), and sensory impairments were the common risk factors identified. The cognition status of orientation and attention showed improvement, despite failing to reach statistical significance (p > 0.05). For staff, the project enhanced their knowledge and confidence in delirium care. 68.1% of nurses reported supportive feedback regarding the project. The result might be limited by a small sample size in a short data collection period. To facilitate early discharge, a considerable proportion of patients were discharged home or transferred to convalescent wards without fully recovering from fluctuating cognition status. Therefore, a longitudinal study across various settings could be a future direction to examine the effect of this project. To conclude, this study demonstrated an embryonic step in enhancing quality care in delirium patients during the acute phase. Further study is required to extrapolate the effect of nursing care on their recovery.
