BMJ Qual Improv Report 4: doi:10.1136/bmjquality.u206598.w2653
  • BMJ Quality Improvement Programme

Improving early recognition of delirium using SQiD (Single Question to identify Delirium): a hospital based quality improvement project

  1. Pamela Cumming
  1. School of Nursing & Midwifery, University of Dundee
  1. Correspondence to
    Elaine McCleary mcclearyelaine{at}
  • Received 23 October 2014
  • Revision requested 12 November 2014
  • Revised 26 November 2014
  • Published 7 January 2015


Delirium is a serious condition associated with poor outcomes which can be prevented and treated if recognised early. Older people and people with dementia or severe illness are more at risk of delirium. SQiD is a simple prompt question which asks, "Is this patient more confused than before?" Focusing specifically on patients aged 75 and over, this project aimed to increase awareness and usage of SQiD to help improve early recognition of delirium, in accordance with the Healthcare Improvement Scotland national initiative. This project was carried out by two student nurses during an eight week clinical placement in the acute surgical receiving unit (ASRU) of Ninewells Hospital, Dundee, Scotland.

Qualitative and quantitative methodology was used to establish baseline data which revealed that only 35% of the multidisciplinary team (MDT) were aware of SQiD, with only 15% using SQiD. Initial activities involved raising awareness of SQiD by means of information cards and posters. Once awareness was raised, the usage of the SQiD question by nurses was tested. Finally, the SQiD question was incorporated into the nursing care round forms and usage recorded. Following these awareness raising activities we noted an increase of 83% awareness and 20% use of SQiD. Incorporating the SQiD question into the hourly care round forms increased awareness to 100% and usage to 50%.

Although this small scale project could be viewed as a success, the requirements for sustainability depend upon further implementation and spreading of the change. Sustained improvement is also dependent upon the implementation of the care rounds.

As nursing students, undertaking this improvement project has provided valuable lessons in both quality improvement science and personal learning. The improved knowledge and understanding of effective communication and the intricacies of team working is transferrable and can be applied to future nursing practice.

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