Education for Nurses Improves Delirium Screening Rates

Early identification with the 4AT screening tool can help nursing staff effectively manage delirium, according to research presented at the Gerontological Advanced Practice Nurse Association 2025 Annual Conference (GAPNA 2025), held from September 11 to 13, 2025, in Las Vegas, Nevada.

“Delirium is an acute change in cognition, which typically involves fluctuation,” said Amaka Opute, DNP, a nurse practitioner (NP) at University of Texas Southwestern Medical Center. “It is usually characterized by inattention, disorganized thinking, and/or altered level of consciousness.

Dr Opute explained that up to 1 in 3 delirium cases go undiagnosed, and not every clinician has a clear understanding of the importance of screening for delirium.

“The reason why it matters is because there is a 50% incidence of delirium in the postoperative period, which is usually associated with adverse outcomes such as prolonged hospital stay, falls, delayed functional recovery, and increased morbidity and mortality,” she said.

After gathering baseline delirium screening rates in the neurosurgical unit (91% in March 2024), Dr Opute and her colleagues had nursing staff participate in mandatory 15-minute monthly educational sessions and weekly 1-on-1 education with the unit educator to learn about the 4AT screening tool (Alertness, Abbreviated Mental Test-4, Attention, and Acute Change or Fluctuating Course).  They also conducted routine chart audits and provided additional educational support to nurses when needed. They aimed to raise the unit’s delirium screening rate to 96% by August 2024.

“The 4AT screening tool is a rapid screening tool for the diagnosis of delirium and cognitive impairment. It has a sensitivity and specificity of 88%; it can be done in less than 2 minutes, and it doesn’t require a lot of education,” Dr Opute said.

The reason why it matters is because there is a 50% incidence of delirium in the postoperative period, which is usually associated with adverse outcomes such as prolonged hospital stay, falls, delayed functional recovery, and increased morbidity and mortality.

The unit’s delirium screening rate rose to 92% in April, 96% in May, 97% in June, and 94.6% in July 2024. Dr Opute and her colleagues concluded that staff education about consistent 4AT use can effectively improve delirium diagnosis rates, and in turn prevent adverse outcomes for patients.

Dr Opute indicated that the next steps for her and her team are to implement electronic record reminders for nurses to conduct delirium screenings, as well as introduce delirium care order sets.

This article originally appeared on Clinical Advisor