40% of hospital acquired delirium may be preventable but often goes unrecognized.
“Although it’s not uncommon for healthcare professionals to manage post-operative delirium, there is always opportunities for prevention and better treatment,” says Joanna Lynch, a Psychiatric Nurse Coordinator for the Multi-Organ Transplant Program at Toronto General Hospital (TGH).
Joanna and the Consult-Liaison Psychiatry team from UHN are working with staff and patients to create awareness around post-operative delirium. They do this by performing ongoing delirium training for team members across UHN, including constant observers and chart audits on specific units to provide feedback on teams’ delirium assessment and management.
“Since delirium is a medical emergency, treating the underlying cause of delirium whether that is an infection, trauma, or hypoxia is a critical first step. Here’s what staff can do to detect delirium earlier,” says Lynch.
First, use the Confusion Assessment Method (CAM) tool and the Policy & Procedure Manual Clinical – Delirium Prevention & Management on the UHN intranet.
- iPhone: http://www.deliriumuhn.org
- iPad: http://www.deliriumuhnapp.com
- Android: google.com
- Blackberry: http://www.deliriumuhnapp.com
Third, ensure safety-decrease risk of falls, verbal de-escalation strategies if patient becomes irritable. Use 15 non-pharmacological management strategies which include (but are not limited to):
- Therapeutic communication- acknowledge patient’s feelings, speak clearly and slowly, use interpreters when necessary, ensure call bell within reach
- Promoting healthy sleep pattern (Provide periods of uninterrupted sleep)
- Psychosocial support – provide reassurance, encourage family participation, maintain continuity of care, frequent interactions
- Provide familiar objects, orient about equipment and routine
- Decrease or increase environmental stimulation’s according to patient needs
- Reassess medications
- Monitor vital signs, blood work, and bowel/bladder functioning
- Inter professional team approach
- Teach patient and family symptoms to report
- Ensure patient has hearing aid in if usually worn
- Ensure glasses are brought in and available to patient
- Immobility – ambulate or active range of motion
- Monitor medications – make sure patient is on the least number, the right drug and the lowest dose
- Make sure patient is hydrated
- Assess for pain and treat as required
“Even though staff mange delirium every shift, it is important for patients and families to be aware of symptoms and report changes in behavior to their clinical care provider to ensure early detection,” says Lynch.
Here are 6 helpful tips to work with families of patients with delirium.
- Explain what delirium is, use simple terms such as: It is a condition that may cause patients to be confused in their thinking. Delirium is a physical problem (a change in the body) than can alter one’s psychological state (change in how the mind works).
- Try not to be upset about the things your loved one might say
- Limit the number of visitors that see your loved one until delirium resolves
- Provide your loved one with support and reassurance
- Take care of yourself
- Provide them with patient and family education delirium brochure for further information: -Delirium (What delirium is, the signs and symptoms, how it can be treated, how friends and family can help, and where to find more information or resources.)-How You Can Help Prevent Delirium in the Hospital, to loved ones of patients what delirium looks like and what they can do to help. Accompanying poster, How You Can Help Prevent Delirium in the Hospital, can also be ordered through the Printing Department.)
“After managing a patient with delirium, one last important step for staff is to reduce their own stress” says Lynch. “Participating in the debriefing process if a critical incident occurs, not taking behaviors personally, taking care of your physical and mental health, and remembering that you are not alone. The prevention and management of delirium is a team approach.”
If you would like more information or assistance contact the UHN Delirium Champions in your program or area. They provide support related to screening prevention and management of patients who are experiencing delirium.