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Delirium Pathway - OTLPCM002-3

1. The delirium care pathway provides guidance on detecting and managing delirium in adult inpatients. It outlines steps to recognize, diagnose, consider the cause of, and manage delirium. 2. Key steps include obtaining a history, looking for symptoms of delirium, completing a 4AT assessment to diagnose delirium, investigating potential precipitating and predisposing factors, and starting a delirium care plan. 3. The delirium care plan involves correcting underlying causes, considering low-dose short term antipsychotics if the patient is distressed, repeating the 4AT daily, and contacting specialists if no improvement is seen after 72 hours. Environmental, medical and nursing interventions are recommended.

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0% found this document useful (0 votes)
211 views1 page

Delirium Pathway - OTLPCM002-3

1. The delirium care pathway provides guidance on detecting and managing delirium in adult inpatients. It outlines steps to recognize, diagnose, consider the cause of, and manage delirium. 2. Key steps include obtaining a history, looking for symptoms of delirium, completing a 4AT assessment to diagnose delirium, investigating potential precipitating and predisposing factors, and starting a delirium care plan. 3. The delirium care plan involves correcting underlying causes, considering low-dose short term antipsychotics if the patient is distressed, repeating the 4AT daily, and contacting specialists if no improvement is seen after 72 hours. Environmental, medical and nursing interventions are recommended.

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Iftida Yati
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DELIRIUM CARE PATHWAY

Guidance to the detection and management of delirium in adult inpatients

1. RECOGNISE
 DELIRIUM CARE PATHWAY
History of sudden change from usual cognitive baseline (often fluctuating)
 Obtain collateral history from relative/ friend/carer/GP
 Look for: Hypoactivity, Lethargy, Reduced consciousness, Attention deficit,
Guidance to the detection
Sleep disturbance, andHyperactivity,
Hallucinations, management of delirium
slurred in adult inpatients
speech, Confusion Predisposing factors:

Age > 65 years, immobility, pain,


2. DIAGNOSE dementia, sensory impairment,
pelvic/limb/NOF #, previous
Complete 4AT (on reverse) record score and delirium diagnosis in notes episodes of delirium

 4 or above: possible delirium +/- cognitive impairment


 1-3: possible cognitive impairment
 0: delirium or severe cognitive impairment unlikely (but delirium still
possible if [4] information incomplete)

3. CONSIDER CAUSE Precipitating factors:

• Investigations: FBC, UEs, CRP, LFT, Ca, B12, Folate, TFT, Urinalysis, CXR, ECG, Infection, acute illness, surgery,
consider neuroimaging (CT/MRI), bladder scan, rule out constipation, cognitive polypharmacy, catheterisation,
impairment pain assessment scale (on intranet), medication review metabolic disorder, electrolyte
disturbance, dehydration, low
BP, hypoxia, pain, environment,
4. MANAGEMENT: START DELIRIUM CAREPLAN constipation, urine retention ,
Some medications such as
Medical Environmental steroids etc.
 Adequate lighting/use of
1. Correct and manage precipitating sensory aids (prescription
and predisposing factors glasses/hearing aids)
 Staff continuity
2. If in distress with risk to  Promotion of mobility and
self/others: senior review, encourage independence
document capacity and best  Falls prevention strategies  If no clinical
interest and consider:  Orientation aides (clock and improvement is observed
calendar) after 72 hours:
Regular short term, low dose  Promote sleep hygiene
antipsychotic (1 week or less)  Provide occupation and  Re-evaluate and
such as Haloperidol or distraction optimise management
Risperidone. Start at lowest  Oral hydration and nutrition if  Repeat 4AT
clinically appropriate dose, titrate safe to do so
cautiously according to  For further advice and
 Consider close supervision
symptoms. Contraindicated in guidance please
 Involve relatives/carers in day
Parkinson’s disease, Lewy to day management (open contact Jo Dron or Iain
body syndromes and visiting times). Offer ‘ Delirium’ Tredway on 3208
prolonged QTc. leaflet. /6845 bleep 955
In lewy body dementias and
Parkinson’s disease use Avoid: restraints; confrontation; ward
Quetiapine. moves; unnecessary interventions/ Update September 2018
3. Repeat 4AT daily until investigations; catheters; excess OTLPCM002
environmental noise
resolved
4. Repeat 4AT as often as needed

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