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SIGN157: Risk reduction and management of delirium
Euan Bremner, Karen Graham, Aimie Little, Domenico Romano, Gaynor Rattray, Carolyn Sleit, Karen Martin, James McKillop, and Rachael Wybrew
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Type of Media:
Medical Professional Education
Media Originally for:
Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals
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Primary Focus of Media:
Pre-Use of PICS Designation
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.
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