1. Identify Risk
   1. Chart review
   2. Assessment of risk factors: cognitive impairment, advanced age, severe illness, sensory deficits, infection, polypharmacy, sleep deprivation, dehydration
2. Screen
   1. Clock-in-the Box Assessment
   2. Modified Richmond Agitation and Sedation Scale (mRASS)
   3. Days of the Week Backward (DOWB) and Months of the Year Backward (MOYB)
3. Intervene
   1. Alert healthcare providers to risk factors
   2. Complete a thorough medication reconciliation to reduce polypharmacy, when possible
   3. Utilize Delirium Toolbox items to promote sleep, cognitive stimulation & orientation, increase ambulation, and improve sensory deficits
4. Monitor
   1. Evaluate for prevalent delirium upon each transition of care
   2. If patient develops delirium, create an individualized plan for rehabilitation
5. Track Outcomes
   1. Staff education
   2. Reduction in: Medical center costs, restraint use, length of stay, and readmission rates

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The Delirium Toolbox is a VA quality improvement project developed by James Rudolph that evolved from a VABHS Healthcare Failure Effects-Modes Analysis (HFEMA) and VABHS Delirium Task Force. The Delirium Toolbox is funded via a T21 mechanism administered by the Office of Geriatrics and Extended Care to prevent long-term institutionalization in high-risk veterans.