ACE-T at the bedside: narrated walkthrough transcript
https://theace-t.com/walkthrough.html

You have just completed a delirium screen and the result is positive. Alongside arranging clinical assessment, you need to decide what to do now. What might be contributing? How is the patient feeling? What needs to be communicated? ACE-T brings these early nursing actions together, so you have a clear place to start.

The problem is not a shortage of advice about delirium. Research papers and clinical protocols recommend quite different combinations of actions, often without clearly saying who should carry them out, or when. ACE-T was developed to make the initial nursing contribution more explicit. It supports a team response rather than asking nurses to manage delirium alone.

There are three sections: Acute Triggers, Patient Experience, and Treatment. This is a tool for the treatment of delirium, not a delirium prevention programme. It follows a positive detection result; it does not make the diagnosis. Use it alongside clinical assessment and your local delirium pathway, not as a replacement for either.

The aim is to address the relevant suggestions within the first four hours after detection. That gives the early response a time frame. It does not mean waiting four hours to act, and it is not a validated safety threshold. Escalate urgent concerns immediately. The sections can be used together; they are not a queue.

Begin by checking observations: pulse, blood pressure, oxygen saturation, respiratory rate, temperature, and conscious level. Check capillary blood glucose and whether routine blood tests have been sent. Escalate abnormal findings as required. If further investigations are needed, discuss these with the appropriate clinician, following local policy and your scope of practice.

Assess for urinary retention and constipation. Review hydration, nutrition, and pain. Consider infection assessment where clinically indicated, rather than routine urine testing for every positive delirium screen. Check whether medication review has been completed, and raise possible medicine-related problems. The tool helps you bring together findings, gaps, and concerns that need action.

Now consider the patient’s experience. Observe for distress, ask how they are feeling, and note any agitation. The Quick Distress Assessment Tool may be useful where appropriate. Its questions are simple: “How are you feeling? Is anything bothering you?” A patient does not have to be agitated to need reassurance or help with distress.

Offer reassurance and reorientation. Explain who you are and what is happening. Check that glasses, hearing aids, and other communication aids are available. Consider the environment, including whether a single room is needed. Involve relatives, friends, or carers where appropriate. These suggestions keep the person’s experience in view while the team assesses and treats contributing problems.

For Treatment, consider falls risk and immediate supportive measures. Fluids or oxygen may be needed, but neither is an automatic response to delirium. Document delirium or suspected delirium, as appropriate, and the local screening score. Remember that a positive screening result requires clinical assessment; it is not, on its own, a confirmed diagnosis.

Communicate the score and relevant findings to the clinical team. Inform the family and provide a delirium leaflet to the patient and family where appropriate. Discuss the treatment plan with the multidisciplinary team. Your nursing care and observations complement the work of doctors, advanced practitioners, therapists, pharmacists, and other colleagues, according to local roles.

ACE-T is a set of suggestions, not an instruction to do every item for every patient. Use your professional judgement about what is needed, what should be added, and what is unnecessary. Wording may differ by setting or country. Relevant actions can be repeated during ongoing care; treatment does not stop when four hours have passed.

The early pilot produced encouraging staff feedback, not proof of improved patient outcomes. Think of ACE-T as a brief prompt for a more explicit nursing response: look for acute triggers, attend to the patient’s experience, and bring treatment and communication together. Take a look with your team, and consider using it with the next suitable patient.