- The evidence in the prevention of delirium favours multi-dimensional approaches that combine a number of component interventions (see below). This is ideally suited to an inter-professional team approach. It is also important to recognize that optimizing non-clinical hospital operations such as purchasing and environmental design processes can play a key role in an organization-wide delirium strategy.
|OS ORGANIZATIONAL SUPPORT STRATEGIES|
|PC PROCESSES OF CARE STRATEGIES|
|EBEMOTIONAL AND BEHAVIOURAL ENVIRONMENT STRATEGIES|
|Eth ETHICS IN CLINICAL CARE AND RESEARCH STRATEGIES|
|Phys PHYSICAL ENVIRONMENT STRATEGIES|
- In some settings, it may be possible to recruit and train volunteers to assist the inter-professional team with some of the components of delirium prevention. Successful outcomes have been demonstrated in multi-component protocols utilizing volunteers6 as well as programs integrated into the daily practice of regular hospital staff.7
- There is evidence that pre-operative assessment of older orthopaedic surgery patients by a geriatrician or geriatrics team can reduce the incidence of delirium.8
- When delirium is diagnosed or suspected, management involves prompt assessment and correction of its underlying cause(s), in addition to incorporating multi-component interventions in the care plan.2
- There is insufficient evidence to support pharmacologic intervention for the prevention or management of delirium.4 Guidelines that have been developed reserve the judicious use of anti-psychotic medications, combined with non-pharmacologic approaches, to manage severe behavioural disturbances due to delirium.2
Other Helpful Resources:
Resources compiled at Sunnybrook Health Sciences Centre for the Toronto RGP by Deborah Brown-Farrell, RN, MHSc, ACNP.
1 Michaud L, C Bula, A Berney, V Camus, R Voellinger, F Stiefel, B Burnand, and the Delirium Guidelines Development Group (2007). Delirium: Guidelines for general hospitals. Journal of Psychosomatic Research 62: 371-383.
2 Clinical Epidemiology and Health Service Evaluation Unit (2006). Guidelines for the Management of Delirium in Older People. Melbourne, Australia: Victorian Government Department of Human Services, 103p.
3 National Clinical Guideline Centre (2010). Delirium: diagnosis, prevention, and management. London, UK: National Clinical Guideline Centre, 662p.
4 Holroyd-Leduc JM, F Khandwala, and KM Sink (2010). How can delirium best be prevented and managed in older patients in hospital? Canadian Medical Association Journal 182(5): 465-470.
5 Siddiqi N, R Holt, AM Britton, and J Holmes (2007). Inteventions for preventing delirium in hospitalized patients. Cochrane Database of Systematic Reviews, Issue 2. Article No: CD005563. DOI: 10.1002/14651858.CD005563.pub2.
6 Inouye SK, ST Bogardus Jr, DI Baker, L Leo-Summers, and LM Cooney Jr (2000). The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Journal of the American Geriatrics Society 48: 1679-1706.
7 Vidan MT, E Sanchez, M Alonso, B Montero, J Ortiz, and JA Serra (2009). An Intervention Integrated into Daily Clinical Practice Reduces the Incidence of Delirium During Hospitalization in Elderly Patients. Journal of the American Geriatrics Society 57: 2029-2036.
8 Marcantonio ER, JM Flacker, RJ Wright, and NM Resnick (2001). Reducing delirium after hip fracture: A randomized trial. Journal of the American Geriatrics Society 49: 516-522.