Delirium is an acute disturbance in a person’s attention, awareness and cognition that can be caused by an acute medical condition or medication changes. Delirium is serious and may be the only sign of a deteriorating patient.
Delirium should be treated as a medical emergency.
Delirium is common in older patients, yet it is often overlooked, misdiagnosed and poorly managed. This can lead to the person experiencing falls, incontinence, malnutrition, dehydration, infections and pressure injuries.
Delirium can often be prevented and can be treated and managed. As clinicians we must listen to the families of our patients when they tell us the person seems confused. If the person does not have family or friends visiting regularly, we need to be extra vigilant to detect changes in a person’s behaviour and investigate promptly. All team members are responsible for this and should feel confident to escalate their concerns.
This topic gives an overview of delirium, its risk factors, how to prevent it occurring and how to manage its symptoms once diagnosed.
In addition to following health service policy and procedures, consider the recommended actions and discuss them with colleagues and managers.
Delirium is a serious condition
Delirium is a serious and common condition, and may be the only sign of medical illness or a rapidly deteriorating patient.
Delirium and ageing
Delirium affects up to 50 per cent of older people in certain hospital settings. Older people with an existing cognitive impairment, such as dementia, experience higher rates of delirium.
Identifying delirium – screening and assessment
Delirium assessment aims to confirm the diagnosis, identify and treat the causes, and manage and relieve the symptoms.
Preventing and managing delirium
There are many things we can do to help older people and their families and carers understand, prevent and manage delirium.
Delirium and discharge planning
To help patients make a smooth transition, consider how they will manage, how their family or carer will cope, and what services and supports are required.
Further Information - delirium
Educational and information resources available on improving care for older people with delirium in hospital.
All public and private hospitals are required to be accredited to the Australian Commission on Safety and Quality in Healthcare’s (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards. The primary aims of the standards are to protect the public from harm and to improve the quality of health service provision. Assessment to the second edition of the NSQHS Standards commenced in January 2019. The second edition comprises eight standards that provide a nationally consistent statement about the level of care consumers can expect from health services.
The Comprehensive Care Standard (Standard 5) aims to ensure that patients receive comprehensive health care that meets their individual needs, and considers the impact of their health issues on their life and wellbeing. It also aims to ensure that risks of harm for patients during health care are prevented and managed through targeted strategies. These include integrating patient care processes to identify patient needs and identifying actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care.
Information is presented in the Older People in Hospital learning topics that complements Standard 5 and other NSQHS Standards including the; Partnering with Consumers Standard (Standard 2), Medication Safety Standard (Standard 4), Communicating for Safety Standard (Standard 6) and Recognising and Responding to Acute Deterioration (Standard 8).
Reviewed 05 October 2015