The Intensive Care Unit (ICU) is situated in the Ulster Hospital in Dundonald, Belfast. The hospital is the major acute hospital for the South Eastern Health and Social Care Trust and delivers a full range of acute services for the population. Staff had noticed that ICU patients and their relatives returning to the follow up clinic were describing concerning issues including nightmares, sleep deprivation, hallucinations and flashbacks. These contributed to them being unable to adjust to being home and leading a regular family life, creating stress for both the patient and their family. To build on the work of the follow up clinic and to further improve the psychological support for patients, staff thought that a possible solution was the introduction of patient diaries.

Delirium is an acute deterioration in mental functioning arising over hours or days that is triggered mainly by acute medical illness, surgery, trauma, or drugs. It was previously termed ‘acute confusional state’. Delirium is independently linked with poor outcomes including medical complications, falls, increased length of hospital stay, new institutionalisation, and mortality.It can cause significant patient and carer distress.
The main features of delirium are acute cognitive deficits and altered level of arousal, with up to half of patients also experiencing hallucinations or delusions. Delirium varies in duration, mostly resolving within days, but in some people it can last weeks or months.
Delirium is among the most common of medical emergencies. A UK study found a prevalence of 20% in adult acute general medical patients. The prevalence is higher in particular clinical groups, such as patients in intensive care units (ICU). It affects up to 50% who have hip fracture and up to 75% in intensive care. Several predisposing factors increase the risk of delirium, including older age, dementia, frailty, the presence of multiple comorbidities, male sex, sensory impairments, a history of depression, a history of delirium, and alcohol misuse.
Despite its importance, there are deficiencies in care of people with delirium in Scotland. It is underdiagnosed, and the treatment of patients with established delirium is variable. Preventative measures can reduce the incidence of delirium, yet few clinical units have formal delirium risk-reduction programmes.
Experience gained from quality improvement programmes in Scotland shows that advances can be made. There is potential to improve clinical practice by reducing variation in the standards of assessment and management of people with delirium. This new national guideline on delirium provides a critical focal point for Scotland-wide improvements in delirium care. Because delirium is so common, all healthcare staff having contact with acutely unwell patients need to assume responsibility for detecting and treating it, as well as aiming to reduce the risk of delirium occurring. Those working in the long-term care environment should be able to recognise delirium, reduce risk, and monitor those in their care to resolve delirium.

Aim: To describe a randomized controlled trial protocol designed to evaluate the effectiveness of mobile health based Preterm Home Care Program (mHealthPHCP) known as "NeoRaksha" mobile health application in improving parent-infant-interaction, growth and development of preterms.