Clinical indicators that can contribute to delirium

FactorPreventive intervention
Cognitive impairment and/or disorientation
  • Provide appropriate lighting and clear signage. A clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk.
  • Reorientate the person. Explaining where they are, who they are, and what your role is.
  • Introduce cognitively stimulating activities (for example, reminiscence).
  • Facilitate regular visits from family and friends.
Dehydration and/or constipation
  • Encourage the person to drink. Consider offering subcutaneous or intravenous fluids if necessary.
  • Seek advice if necessary when managing fluid balance in people with comorbidities (for example, heart failure or chronic kidney disease).
Hypoxia
  • Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate.
Infection
  • Look for and treat infection.
  • Avoid unnecessary catheterisation.
  • Implement infection control procedures in line with ‘Infection control’ (NICE clinical guideline 2).
Immobility or or limited mobility or
  • Encourage people to:

    mobilise soon after surgery

    walk (provide walking aids if needed – these should be accessible at all times)

  • Encourage all people, including those unable to walk, to carry out active range-of-motion exercises.
Multiple medications
  • Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications.
Pain
  • Assess for pain. Look for non-verbal signs of pain, particularly in those with communication difficulties (for example, people with learning difficulties or dementia, or people on a ventilator or who have a tracheostomy).
  • Start and review appropriate pain management in any person in whom pain is identified or suspected
Poor nutrition
  • Follow the advice given on nutrition in ‘Nutrition support in adults’ (NICE clinical guideline 32).
  • If people have dentures, ensure they fit properly.
Sensory impairment
  • Resolve any reversible cause of the impairment, such as impacted ear wax
  • Ensure working hearing and visual aids are available to and used by people who need them.
Sleep disturbance
  • Promote good sleep patterns and sleep hygiene4 by:

    avoiding nursing or medical procedures during sleeping hours, if possible

    scheduling medication rounds to avoid disturbing sleep, and

    reducing noise to a minimum during sleep periods.

From: 3, Key messages of the guideline

Cover of Delirium
Delirium: Diagnosis, Prevention and Management [Internet].
NICE Clinical Guidelines, No. 103.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre - Acute and Chronic Conditions.

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