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Delirium
Short Text
Introduction
This pathway covers the prevention, diagnosis and management of delirium.
Delirium (sometimes called 'acute confusional state') is a clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course.
It is a common but serious and complex clinical syndrome associated with poor outcomes.
Delirium may be present when a person presents to hospital or long-term care or may develop during a hospital admission or residential stay in long-term care.
Delirium can be hypoactive delirium or hyperactive delirium but some people show signs of both (mixed). Hypoactive and mixed delirium can be more difficult to recognise.
The main focus of this pathway is 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').
This pathway does not cover children and young people (under 18 years), people receiving end-of-life care, people with intoxication and/or withdrawing from drugs or alcohol or with delirium associated with these states.
Source guidance
The NICE guidance that was used to create the pathway.
Delirium. NICE clinical guideline 103 (2008)
Parkinson's disease. NICE clinical guideline 35 (2006)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education tools
NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
3 May 2013 Minor maintenance updates
04 December 2012 Minor maintenance updates
Supporting information
Has the person any indicators of delirium? These are recent (within hours or days) changes in:
- Cognitive function: for example, worsened concentration, slow responses, confusion.
- Perception: for example, visual or auditory hallucinations.
- Physical function: for example, reduced mobility, reduced movement, restlessness, agitation, changes in appetite, sleep disturbance.
- Social behaviour: for example, lack of cooperation with reasonable requests, withdrawal, or alterations in communication, mood and/or attitude.
These may be reported by the person at risk, or a carer or relative.
Be particularly vigilant for signs of hypoactive delirium (marked in bold).
Glossary
Subtype of delirium characterised by people who have heightened arousal and can be restless, agitated and aggressive.
Subtype of delirium characterised by people who become withdrawn, quiet and sleepy.
A team of healthcare professionals with the different clinical skills needed to offer holistic care to people with complex clinical problems such as delirium.
Residential care in a home that may include skilled nursing care and help with everyday activities. This includes nursing homes and residential homes.
Diagnostic and Statistical Manual of Mental Disorders
Confusion Assessment Method
Confusion Assessment Method for the intensive care unit
Person presents to hospital or long-term care
Person presents to hospital or long-term care
Person presents to hospital or long-term care
Think delirium
Be aware that people in hospital or long-term care may be at risk of delirium. Delirium can have serious consequences (such as increased risk of dementia and/or death) and may increase the length of stay of people already in hospital and their risk of new admission to long-term care.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeInformation for people at risk of or with delirium
Information for people at risk of or with delirium
Information for people at risk of or with delirium
Offer information to people with or at risk of delirium, and their family and/or carers which:
- explains that delirium is common and usually temporary
- describes people's experience of delirium
- encourages people at risk and their families and/or carers to tell their healthcare team about any sudden changes or fluctuations in usual behaviour
- encourages the person who has had delirium to share their experience of delirium with the healthcare professional during recovery
- advises the person of any support groups.
Ensure information meets cultural, cognitive and language needs.
NICE has written information for the public explaining the guidance on delirium.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePreventing and diagnosing delirium
View the 'Preventing and diagnosing delirium' pathTreating delirium
View the 'Treating delirium' pathPaths in this pathway
Pathway created: September 2012 Last updated: May 2013
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