Delirium

[Audio] Welcome to the Delirium education video. “Delirium is real for the patient” Roger M Garrett.

[Audio] Roger Garrett a delirium survivor in 2019 wrote about his experience with delirium, he penned, "I don't know where I am or where I have been, but I am suddenly awake and terrified! I am being held down by shadowy people who have a knife down my throat. They are demanding a ransom from my family who are far far away. All I can do is fight; fight for my life; keep on fighting with all my strength. It is kill or be killed".

[Audio] Melissa Mattison defines delirium as "an acute state of brain failure marked by sudden onset of confusion, a fluctuating course, inattention, and often abnormal levels of consciousness".

[Audio] Delirium is often misdiagnosed as dementia especially in our older population. Some of the key differences occur around the onset, course, duration, consciousness, attention and orientation. The onset of delirium is acute and occurs suddenly over hours or days. Dementia is gradual and develops over months to years. The course and duration of delirium fluctuates and often there are times of lucidity. the episodes are usually short but can last for more than 6 months in some cases, dementia is progressive and decline occurs over years to eventual death. People with delirium have altered/fluctuating consciousness and orientation, short attention spans, have difficulty concentrating on tasks and easily distracted. People living with dementia do not normally have these fluctuations, however their orientation does become impaired as the disease progresses..

[Audio] Some risk factors make people liable to increased risk of delirium such as age, current cognitive issues, previous delirium, decreased levels of mobility, hearing and vision, polypharmacy, dehydration and malnutrition. Introduction to such complications as infection, pain, acute illness, urinary retention, constipation, sleep deprivation and surgery can bring about an episode of delirium..

[Audio] So how do we manage delirium in the acute care setting? All adult impatient should have the adult inpatient risk assessment form completed on admission. The delirium pathway provides a guide of the assessment processes to follow for a patient presenting or suspected of developing a delirium. If the patient is over the age of 65 years or 45 years for Aboriginal or Torres Strait islander, known cognitive impairment, dementia or previous delirium, serve illness or at risk of dying, hip fracture, confused, agitated, disorientated or drowsy or concerns around cognition by others are raised, a history of the patient should be documented, along with a 4 A T and monitoring for new confusion with the C on the SAGO chart..

[Audio] The three reviewed mental health screen questions on the adult inpatient risk assessment form include how patients are feeling emotionally, thoughts of self harm and are staff, carers or family concerned for the patient's mental health. Referral to a medical officer should initiated with a yes response. For new onset of confusion or a changes in patient's behaviour the C on the SAGO chart should be document and escalation to a medical review should take place as per the CERs response..

[Audio] A 4 A T is an assessment test for delirium and cognitive impairment. It assesses 4 components. Alertness, A M T 4, Attention, Acute changes or fluctuation. 4 or above indicates Possible delirium + or minus cognitive impairment.

[Audio] If delirium is detected a delirium notification sticker and daily CAM should be completed and referral to a medical officer made.

[Audio] A mental state observation form should be completed when new onset of confusion is identified. The form should be completed daily after interaction and observation of the patient, document in the progress notes and escalate as appropriate..

[Audio] For patients over 65 years or 45 years for Aboriginal or Torres Strait islander a delirium screen for older adults should be completed.

[Audio] If delirium is detected an urgent clinical review should be initiated and investigations into new onsets of confusion should occur. Such as treatment of uncontrolled pain, a medication review by pharmacy for possible drug interactions, review for constipation, urinalysis and bladder scan for urinary tract infections and urinary retention and correction of metabolic imbalances, hypoxia and hypercapnia.

[Audio] Implementation of prevention and management strategies for patients who have a delirium or who are at risk of developing a delirium can minimise patient distress. Some management strategies include screening at risk patients, encourage hydration, nutrition, mobilisation and normalise sleep-wake cycle, reduce the use of restraints and antipsychotic use, monitor bowels, urine output and pain control and provide a supportive environment. Implementation of the 24 hours behaviour log, delirium management care plan and the get to know me tools top 5 and sunflower chart help individualise patient cares.

[Audio] Delirium can cause complications that can significantly impact a patient wellbeing, increase their length of stay in hospital, leading to functional decline, pressure injuries, falls, dehydration and embarrassment. Delirium can also have longer term impacts on social and financial loss and post-traumatic stress disorder..

[Audio] To summarise Delirium is a medical emergency an urgent clinical review should be initiated for changes in a patient's cognitive status Follow the delirium pathway Assess a patient's cognitive status using the appropriate tools Identify causes for delirium Implement prevention and management strategies Talk to the family/ carer Refer to the dementia and delirium CNC when appropriate.

Other available Education & Resources. Mattison , M. (2020) Delirium. Retrieved 21st February 2022 from https://oce.ovid.com/article/02144567-202010060-00001/HTML Standard 8 Recognising and Responding to Acute Deterioration Standard 5 Comprehensive Care Delirium Clinical Care Standard PPG: Screening Assessment and Management of Delirium in Adults Hospital Pathway: Delirium - JHH Delirium education module Delirium Screening and Prevention Diagnosis Treatment Practice Improvement Hospital-Acquired Complication 11 Delirium.

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