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Submitted By PJWEST
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Pages: 26

Guidelines for the diagnosis and Management of Older People with Delirium in a general hospital setting

Reference Number
N/A
Version
1
Name of responsible (ratifying) committee
Vulnerable Adults Committee
Date ratified
07.07.2010
Document Manager (job title)
Matron - Department of Medicine for Older People Consultant Geriatrician
Date issued
17.09.2010
Review date
July 2011
Electronic location
PHT Multi-Professional Guidelines
Related Procedural Documents
Acute Confusion Drug Policy
Falls Policy
Key Words (to aid with searching)
Delirium; Confusion

CONTENTS

QUICK REFERENCE GUIDE
3
1.
INTRODUCTION
4 2.
PURPOSE
4 3.
SCOPE
4 4.
DEFINITIONS
4 5.
DUTIES AND RESPONSIBLITIES
5
6.
PROCESS
5 7.
TRAINING REQUIREMENTS
12
8.
REFERENCES AND ASSOCIATED DOCUMENTATION
12
9.
MONTORING COMPLIANCE WITH AND THE EFFECTIVENESS OF, PROCEDURAL DOCUMENTS
13

APPENDIX I
FLOW CHART FOR THE MANAGEMENT OF DELIRIUM
14
APPENDIX II
MINI MENTAL STATE EXAMINATION
15
APPENDIX III
ABBREVIATED MENTAL TEST SCORE (AMT)
16
APPENDIX IV
SOME OF THE DRUGS / GROUPS THAT MAY PRECIPITATE DELIRIUM (THIS LIST IS NOT EXHAUSTIVE)
17
APPENDIX V
DELIRIUM ADUIT TOOL
18
APPENDIX VI
DELIRIUM INFORMATION FOR PATIENTS AND RELATIVES
19
APPENDIX VII
THE CONFUSION ASSESSMENT METHOD (CAM) 37
21

1. INTRODUCTION

Delirium is common in hospitalised patients with a range between 10 and 50% reported in different studies1,2,3. It occurs most frequently in older people (up to 30% of older inpatients) but also commonly in Intensive Care Unit (ICU) patients4, in the alcohol dependent 5 and in the terminally ill6. It can occur in a wide variety of medical situations.

Delirium is often not recognised by clinicians (missed in up to 2/3 of cases) and is frequently poorly managed7. Lack of recognition is important and may occur for a number of reasons including the fluctuating nature of it, overlap with dementia, lack of formal cognitive assessments being used, failure to appreciate the clinical consequences and failure to consider the diagnosis important7.

It is vital that delirium is recognised and appropriately managed because patients who develop delirium have high mortality (twice as likely to die), institutionalisation and complication rates, and have longer lengths of stay than non-delirious patients (up to 8 days has been described)8. There is potential to prevent the onset of delirium in up to 30% of older in-patients9, 10. The National Service Framework for Older People (DOH 2001)11 identifies a fundamental requirement for the NHS to ensure the good and effective management of patients with mental health needs wherever they are being cared for.

This document has been designed to assist clinicians in the achievement of this standard. The guidance contained within this document has been developed in line with the Guidelines for the Prevention, Diagnosis and Management of Delirium in Older People, Royal College of Physicians, 200612, and also draws on the guidelines from the Isle of Wight health care trust 200513.

Note: Clinician is used in reference to Doctors, Nurses and all members of the Multi-disciplinary team (MDT)

2. PURPOSE

The following guideline aims to provide support for clinicians in the recognition, diagnosis and management of older people presenting with the symptoms of Delirium within the acute hospital environment, it is important to remember that patients with delirium can be found in all specialties of the hospital These guidelines do not specifically cover the management of withdrawal of alcohol. Appendix II provides quick reference guides to the guideline.

3. SCOPE
This…