4-AT Assessment Tool

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Questions and Answers

What is the purpose of the 4-AT assessment tool?

To assess a patient's vital signs

To evaluate a patient's mental health history

To gauge a patient's likelihood to have cognitive impairment or be at risk for delirium (correct)

To determine a patient's medication regimen

When should the 4-AT be completed?

Only when the patient is discharged

Every shift, or when there is an acute change in the patient's condition (correct)

Only at the patient's admission

Once a week

What is an example of an altered level of alertness?

Fever

Sleepiness or unresponsiveness (correct)

Hypertension

Pain

What is assessed in items 2 and 3 of the 4-AT?

Patient orientation and attention Signup and view all the answers

What is the purpose of asking the patient to 'Please tell me the months of the year in backwards order, starting at December'?

To evaluate the patient's cognitive function Signup and view all the answers

Why is it important to inform patients about the purpose of the 4-AT?

To enhance compliance with the assessment Signup and view all the answers

What is assessed in the final item of the 4-AT?

Acute change or fluctuating course Signup and view all the answers

When should you select 'yes' for the final item of the 4-AT?

If the patient has had an acute change to their baseline within the last 2 weeks and it is still evident within the last 24 hours Signup and view all the answers

What is the benefit of understanding the patient's overall health goal?

To improve preoperative conversations and risk assessments Signup and view all the answers

What is the purpose of the 'Mandatory Reassessment or Orders for Resuscitative Measures' policy?

To require the attending physician to discuss issues related to the etiologies and outcomes of cardiopulmonary arrest during anesthesia Signup and view all the answers

Why is it important to understand both overall health goals and healthcare treatment preferences?

To better treat the whole patient while identifying impacts of surgical and non-surgical treatment options Signup and view all the answers

What is the primary goal of shared decision making with patients?

To empower patients to reflect upon and identify personal health goals Signup and view all the answers

Why may the Cancellation of the Orders for Resuscitative measures occur?

If the patient and/or their family changes their mind or the patient is booked for a surgical procedure Signup and view all the answers

What do the majority of older adults value at the end of their lives?

Independent decision making Signup and view all the answers

Study Notes

4-AT Assessment Tool

The 4-AT is a standardized assessment tool that evaluates a patient's likelihood of cognitive impairment or delirium risk.
It is completed within ED triage and required to be completed every shift, or when there is an acute change in the patient's condition, by nursing staff as per Kent policy (KH-NUR-308).

Level of Alertness

The first item in the 4-AT assesses the level of alertness, a clinical feature that can indicate delirium.
Altered level of alertness may manifest as sleepiness, unresponsiveness, or agitation.

Orientation and Attention

Items 2 and 3 of the 4-AT assess patient orientation and attention through brief cognitive testing.
The assessment includes questions on the patient's name, date of birth, name of the hospital, and current year.
The attention assessment involves asking the patient to recall the months of the year in reverse order, starting from December.

Acute Change or Fluctuating Course

The final item in the 4-AT assesses acute change or fluctuating course related to alertness, cognition, or other mental functions, including paranoia and hallucinations.
A 'yes' response indicates an acute change in the patient's baseline within the last 2 weeks, which is still evident within the last 24 hours.
Family and caregiver interviews, admission assessments, ambulance records, and facility notes can be used to assess acute change or baseline condition.
A significant change in the 4-AT score requires notification of the provider to review potential causation.

Understanding Patient Goals

Understanding patients' overall health goals is crucial for improving preoperative conversations and risk assessments by focusing on patient-centered outcomes.
Embedding verbatim quotes from patients in the 'SSCP' portion of the history and physical helps understand their goals related to care.

Aligning Health Goals and Treatment Preferences

Patients' overall health goals and healthcare treatment preferences may not always align, emphasizing the need to understand both to treat the whole patient.
Identifying the impacts of surgical and non-surgical treatment options on the patient's health goals is essential.

Orders for Resuscitative Measures (ORM)

Cancellation of ORM may occur if the patient or their family changes their mind or if the patient is booked for a surgical procedure.
The "Mandatory Reassessment or Orders for Resuscitative Measures" policy requires the attending physician to discuss issues related to the etiologies and outcomes of cardiopulmonary arrest during anesthesia.

Code Status and Anesthesia

The attending physician, patient, and/or caregivers will discuss whether the patient's Code Status will be suspended during anesthesia and surgery.
The attending physician may contact the Anesthesia department for consultation with the family to ensure health goals and treatment goals align.

Shared Decision Making

High-quality communication and empowering patients to reflect on their personal health goals are essential for shared decision making.
The majority of older adults value independent decision making at the end of their lives.

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Description

The 4-AT assessment tool evaluates a patient's likelihood of cognitive impairment or risk of delirium. It is used by nursing staff in ED triage and is required to be completed every shift or when a patient's condition changes.