Table 2.

The PINCHME acronym for identifying and managing potential causes of delirium

PainTreat pain appropriately, and identify and manage the underlying cause of the pain.
InfectionIdentify and treat infection only if it is present.
NutritionEncourage oral nutritional intake with foods that the patient enjoys, ideally high in calories. Weigh the patient and refer to a dietitian as appropriate.
ConstipationConstipation should be treated and preventative measures should be considered if prescribing opiates.
HydrationEncourage hydration through oral routes, with a focus on ‘little and often’ if there is not a huge desire to drink. In some cases, intravenous hydration will be required.
MedicationsReview medication and stop or reduce those that may be contributing to the delirium if it is safe to do so. There may be an opportunity to suspend non-essential medications, which can be helpful in promoting other oral intake if this is a priority. Consider use of STOPP/START criteria.
EnvironmentUse reorientation devices (such as clocks and calendars) and lighting that is appropriate to the time of day to promote natural sleep. Photographs of relatives and family visiting can promote a feeling of normality.
  • START = Screening Tool to Alert to Right Treatment; STOPP = Screening Tool of Older Persons' Prescriptions.