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DOSS (Delirium Observation Screening Scale)
DOSS: Nursing observational scale scored over an entire shift. Do not ask the patient questions specifically for this test; score based on routine care observations.
Rate observations over the past shift
1. Dozes off during conversation or activities
2. Is easily distracted by stimuli from the environment
3. Maintains attention to conversation or action
4. Does not finish question or answer
5. Gives answers that do not fit the question
6. Reacts slowly to instructions
7. Thinks he/she is somewhere else
8. Knows which part of the day it is
9. Remembers recent events
10. Is picking, pulling, or restless
11. Is easily or suddenly emotional (crying/angry)
12. Sees/hears things that are not there
13. Is sluggish or drowsy
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Routine shift-by-shift delirium surveillance by nursing staff in acute and long-term care.
Early detection of delirium symptoms over a 24-hour period.
Monitoring delirium severity and fluctuation over time.
Nursing-Led Surveillance
The DOSS is designed specifically for nurses to complete during regular care activities without needing to perform a formal cognitive interview. It captures the fluctuating nature of delirium across shifts.
Section 2
Formula & Logic
Scoring
13 observational items rated as Never (0), Sometimes (1), or Always (1) during the shift.
Total score: 0–13 per shift.
Score ≥ 3: Delirium probable.
Often aggregated over 3 shifts (24 hours) for clinical decision-making.
Because delirium fluctuates, a single point-in-time test (like the CAM) might be falsely negative if performed during a lucid interval. The DOSS mitigates this by observing behaviour over an entire 8-hour shift.
Section 4
Next Steps
Management by Score
Section 5
Evidence Appraisal
Primary Reference
The Delirium Observation Screening Scale: a screening instrument for delirium.
Schuurmans MJ et al. • Res Theory Nurs Pract.. 2003;17(1):31-50. Initial development and validation for nursing use.
Section 6
Origins
Marieke Schuurmans
Developed in the Netherlands by Marieke Schuurmans to bridge the gap between complex diagnostic criteria (DSM) and the practical realities of nursing workflow, providing a simple, behaviour-based scale that integrates into routine vital sign and assessment documentation.
