Delirium

Delirium (sometimes called ‘acute confusional state’) is a common clinical syndrome characterised by disturbed consciousness, distractibility, perceptual abnormalities and impaired cognitive function, which has an acute onset and fluctuating course. It usually develops over 1–2 days. It is a serious condition that is associated with pooroutcomes. However, it can be prevented and treated if dealt with urgently.

 

 

World delirium day webinar 2017

You can view the recording of our world delirium webinar here. Please note that due to technical difficulties there is a gap in slides during one of the presentations. Full copies are available to view below: 
 

Training and awareness resources

 

Delirum poster

Click here to download a delirium ward poster to help raise awareness of the risk factors.

 

Delirium leaflet

With thanks to Bradford Hospitals NHS Trust we have made this delirium leaflet available for all areas. 

 

Delirium prompt card

Inspired by Midyorkshire Hospitals NHS Trust this delirium prompt card can be used to remind professionals about good practice in delirium care. 

Delirium Charter

The Delirium Charter has been developed to help to raise awareness of Delirium. Organisations are asked to adopt the charter as a promise to dem,entia their patients/carers that they are committed to do everything they can to help to prevent, identify and if needed treat delirium in dementia patients who we know are at higher risk.

Delirium Charter Patient/Carer Poster

This Delirium charter poster has been designed to display on notice boards in patient/carer areas

  

Delirium awareness video (#icanpreventdelirium)

Delirium in older adults often goes unrecognised by health care professionals and can be poorly managed. This video was produced by Dr M S Krishnan and Dr Sophia Bennett, Old Age Psychiatrists from Tees, Esk and Wear Valleys NHS Foundation Trust in collaboration with Stockton and Hartlepool Councils and CCG with the aim of improving recognition and management of delirium in any healthcare setting. https://www.youtube.com/watch?v=BPfZgBmcQB8 

 

Is he more confused than normal? A delirium awareness video

Animated video from the Dementia Together NI team to raise awareness of Delirium, its signs and symptoms. To encourage family/carers and Health and Social Care staff to raise any concerns they may have about possible delirium. Produced by HSC Leadership Centre. https://www.youtube.com/watch?v=_c9M4FnDwOc&app=desktop 

 

Patient delirium experience 

This is a 5 minute film in which the patient concerned had a post operative delirium and made a good recovery. He has a high degree of insight into the experience of delirium. The clip highlights the distressing nature of delirium and intensity of the symptoms and it draws atttention to the impact of good quality nursing care and the need to recognise the symptoms of delirium.

 

Recognising early warning signs in care homes

Sutton Clinical Commissioning Group (CCG) was awarded Vanguard status in​ March 2015 – one of only six enhanced health in care home vanguards​ in England. Their aim is to improve the health and quality of life for all care home residents in Sutton by delivering a new care model that offers older people living in care homes improved and integrated health care and rehabilitation services. They've developed this video highlighling early warning signs that can be addressed to prevent falls, sepsis, delirium and kidney damage.

 

 

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Information for patients, carers and families

 

Bradford Teaching Hospital NHS Foundation Trust 2016

Delirium information for relatives and carers

 

Royal College of Psychiatrists 2015

Delirium leaflet 

 

STOP Delirium Project 2007 

Delirium information for relatives

 

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Information for professionals 

 

Delirium experience of patients, families and staff

Developed by Healthcare Improvement Scotland, this report provides details of a project undertaken to explore staff, patients’ and families’ experience of episodes of delirium in an acute hospital setting.

 

Dementia and delirium

Developed by Bradford District Care NHS Foundation Trust this information book highlights behaviours, symptoms & integrated person-centred care for dementia and delirium. They have also produced a Managing Challenging Behaviour Pack for care home settings.

 

NICE Clinical guideline Delirium: prevention, diagnosis and management [CG10] 2010

This clinical guideline describes methods of preventing, identifying, diagnosing and treating delirium. In particular, the guideline focuses on preventing delirium in people identified to be at risk, using a targeted, multicomponent, non‑pharmacological intervention that addresses a number of modifiable risk factors ('clinical factors'). 

 

Preventing delirium while in hospital: Information for people supporting an older person in hospital

Developed by Canterbury District Health Board, the leaflet explains how when an older person becomes ill and goes into the hospital, their risk of developing a delirium increases and what could be done to prevent it.

 

Primary care fact sheet (2015)

Produced by Royal College of Psychiatrists: Why do GP's need to know about delirium? 

 

Local CQUIN Template (2016/2017)

Developed by our colleagues in the Northern England Clinical Network here is a draft local CQUIN template

 

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Assessment tools

 

Confusional assessment method (CAM)

The Confusion Assessment Method (CAM) was originally developed in 1988-1990, to improve the identification and recognition of delirium. It is one of the most requently used methods for detecting delirium because of both its strong validation results as well as its ease of use. More information can be found here.


The 4AT

The 4AT is a validated rapid assessment test for delirium and cognitive impairment. It is widely used in routine clinical practice in the UK and internationally.

 

Single question to identify delirium (SQiD)

Single question to identify delirium (SQiD) is a simple prompt question which asks, "Is this patient more confused than before?" and was first introduced to multi disciplinary staff during delirium training sessions. Asking the SQiD question on a regular basis can identify changes in a patient's condition, which could potentially be delirium. 

 

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Management and risk reduction tools 

 

The FOCUS chart

Developed by Newcastle upon Tyne Hospital NHS Foundation Trust, the FOCUS tool is a prompt to help staff to foucs on meeting the needs of patient in order to reduced potential harm.

 

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Environment advice and checklists

Many health care facilities are not 'dementia or delirium friendly' in design. As people age they lose their ability to distinguish colourcontrast. Patients with cognitive impairment, both delirium anddementia, are particularly vulnerable to the effects of environment interms of worsening their disorientation. Patient areas should be dementia friendly.

 

Environmental audit tools have been published by the Iris Murdoch Centre at Stirling University (http://dementia.stir.ac.uk/).

 

Work has been carried out recently by the Kings fund (http://www.kingsfund.org.uk/sites/files/kf/EHE-developing-supportivedesign-for-people-with-dementia1.pdf) detailing aspects of dementiafriendly environments and audit tools for ward areas and hospitals ingeneral which can be downloaded from the Kings fund website (http://www.kingsfund.org.uk).

 

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Research

 

Single Question in Delirium (SQiD): testing its efficacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale

Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients

 

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Local resources

 

Bradford Teaching Hospital NHS Foundation Trust

Delirium information for relatives and carers

A&E delirium assessment

The DOS (DeliriumObservation Screening) Scale

Delirium guidance for wards

  

Guy's and St Thomas' Charity (London) 

Delirium pathway card

 

Mid Yorkshire Hospitals NHS Trust

Think delirium cards

Mid Yorkshire delirium guidelines

Mid Yorkshire delirium care pathway

CAM screening tool

Mid Yorkshire daily delirium care plan and daily interventions

Think delirium training 

Delirium training

Pre and post training questionnaire

 

Rotherham Doncaster and South Humber NHS Foundation Trust 

Aide memoire

PINCHE ME ward poster 

Dementia and Delirium: A guide for patients,their relatives and carers

Stop delirum presentation 

 

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