Download - MedReg+1 Edwards Delirium
Developing people for health and healthcare
‘Doctor! The mafia are running this place’
Date 24th July
2014
The challenges of managing Delirium
Developing people for
health and healthcare
Developing people for
health and healthcare
What is delirium?
• A disturbance of consciousness
• Change in cognition
• Develops over a short period of time and fluctuates during the course of the day
• Evidence of direct cause by general medical condition
Developing people for
health and healthcare
What is confusion?
Use this term with care.
Confusion is obsolete
Is this delirium or dementia?
It is not pleasant to be confused
Developing people for
health and healthcare
How common is delirium ?
Acute Medical Unit 11-12% (Sampson
2009, 2013)
General medicine 21.4% (NICE 2010)
All emergency admissions 27% (Goldberg
2012)
ICU 70-87% (Pisani 2003)
Developing people for
health and healthcare
Screening
MTS<8CAM score
Developing people for
health and healthcare
Example of screening tool- short CAM
1. Acute onset and fluctuating course
a) Evidence of an acute change in mental status from the patient’s baselineb) The abnormal behaviour fluctuates during the day, comes and goes
2. Inattention
Difficulty focusing attention, easily distracted or difficulty keeping track of what is said.
3. Disorganised thinking
Thinking is disorganised or incoherent, such as rambling or irrelevant conversation, unclearor illogical flow of ideas, or unpredictable switching from subject to subject.
4. Altered level of consciousness
a) Vigilant (hyperalert) b) Lethargic (drowsy, easily aroused) c) Stupor (difficult to arouse) d) Coma (not able to be aroused)
A positive CAM score requires the patient to feature 1 and 2 and either 3 or 4
Developing people for
health and healthcare
What can cause delirium ?
Older age
Dementia
Infection
Dehydration
Malnutrition
Multiple medications
Surgery
Change of environment
Hip fracture
Severe illness
Sleep deprivation
Constipation
Bladder catheterisation
Visual or hearing impairment
Immobility
Alcohol abuse
Pain
Developing people for
health and healthcare
“Delirogenic” environment
•Lack of exercise/movement
•Intermittent noise and light control
•Environmental manipulation
•Sleep deprivation/adjustment
•Controlled fear
•Disorientation
•Sensory deprivation (hearing and vision)
Developing people for
health and healthcare
Principles of management
• Screen• History from an informant• Identify underlying cause• Reassurance and clear information• Avoid moving• Consistency of care• Good lighting • Clear signage; visible clocks• Communication and activities• Encouraging regular visitors
• Prevention is better than cure
Developing people for
health and healthcare
Communication top tips
#hellomynameis……
I’m one of the doctors
Today is Monday
You’re at the X Hospital
You had X problem
Don’t confront/dispute – acknowledge the emotion
Developing people for
health and healthcare
Recognise
Re-orientate
Reassure
Respect