Delirium screening in a stroke unit by nurses using 4AT: Results from a quality improvement project.
Håkon Ihle-Hansen, Nina Johnsen, Tatiana Jankowiak and 6 others
PMID 37209412WHAT IT FOUND
Nurses in a stroke unit screened patients for delirium with 4AT feasibly: 90.3% were screened at least once, nurses reported competence and no significant extra workload, and delirium prevalence was 8.1%.
Key findings
014AT screening by stroke unit nurses was feasible: patients were screened within 24 h in 79.0%, at discharge in 62.9%, and at least once in 90.3%.
02Nurses who completed training felt competent to use 4AT, did not experience significant extra workload, and found it a useful clinical tool.
03Delirium prevalence was 8.1%, and three of five cases occurred after 24 h of admission.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 62 of 110 eligible patients (56%) consented, and women and patients with moderate or severe stroke were underrepresented, so the results may not apply to all stroke admissions. The study was not designed or powered to test 4AT validity, inter-rater reliability, or predictors of delirium, and the number of delirium cases was small. Screening was not performed daily, and 4AT was the only screening tool, so the authors could not rule out missed delirium. The acute change or fluctuating course item was difficult to score, especially at first contact without background information. Patients receiving palliative care were excluded, even though many had moderate or severe stroke. Only 14 nurses who completed training reported their experience, so staff feasibility evidence is limited to a small group.
Declared interests
The research received no specific grant. The authors declared no relevant financial or non-financial interests.
The easy way to misread this
Do not conclude that 4AT screening improved patient outcomes. This was a quality study of 62 patients that showed feasibility and an 8.1% delirium prevalence; it did not test whether screening reduced complications or mortality.