Principles of effective and evidence-based delirium prevention and management.
| Future Hospital Commission's principles of care | Relevance to delirium | Potential interventions |
|---|---|---|
| Fundamental standards of care must always be met | Delirium is under-recognised, preventing patients from receiving appropriate care | Implementation of a validated screening tool |
| Patients have effective and timely access to care, including appointments, tests, treatments and moves out of hospital | ||
| Care is designed to facilitate self-care and health promotion | There is a notable lack of awareness of delirium among the public consciousness | Patient information leaflets, teaching videos involving patients and carers, public lectures and awareness events |
| Good communication with and about patients is the norm | Poor handover between staff regarding patients with delirium prevents its recognition. Patients with delirium may be labelled as ‘poor historians’ | Interprofessional education regarding delirium and simulation training for patients with delirium can provide a powerful learning experience and prompt for reflection |
| Staff are supported to deliver safe, compassionate care, and are committed to improving quality | Negative attitudes and a lack of ownership may exacerbate the patient's fear and anxiety | Patient and public involvement within interprofessional teaching interventions is a powerful potential method for driving attitudinal change |
| Patient experience is valued as much as clinical effectiveness | Delirium is distressing for patients, carers and healthcare professionals | |
| All patients have a care plan that reflects their individual clinical and support needs | Delirium has many causes and so targeted interventions to prevent and treat delirium must be tailored to individual patients | Relatives can play a vital role, facilitated by encouraging more open visiting and by completing a tool, such as the Alzheimer's Society ‘This is me’ |
| Patients do not move wards unless it is necessary for their clinical care | Changes in environment can cause disorientation and may contribute to delirium | Those with or at high risk of delirium should be highlighted as inappropriate candidates for boarding |
| Robust arrangements for the transfer of care are in place | Delirium is associated with an increased risk of incident dementia | Robust communication between secondary and primary care, including using the term ‘delirium’, helps to highlight those who may need further follow up regarding their cognition following discharge |