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Delirium: diagnosis, prevention and management [CG103]

Measuring the use of this guidance

Recommendation: 1.1.1

When people first present to hospital or long-term care, assess them for the following risk factors. If any of these risk factors is present, the person is at risk of delirium. Age 65 years or older. Cognitive impairment (past or present) and/or dementia[4]. If cognitive impairment is suspected, confirm it using a standardised and validated cognitive impairment measure. Current hip fracture. Severe illness (a clinical condition that is deteriorating or is at risk of deterioration)[

What was measured: Hospitals that reported having written procedures in place for multidisciplinary assessessment, including mental state
Data collection end: October 2012
96.7%
Number that met the criteria: 203 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Casenotes reviewed that included evidence that a standardised mental status test had been carried out
Data collection end: October 2012
50.2%
Number that met the criteria: 3548 / 7069
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Hospitals that had a policy or guideline in place to ensure that patients with dementia are assessed for delirium at presentation
Data collection end: October 2012
54.8%
Number that met the criteria: 115 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Hospitals that had a policy or guideline in development to ensure that patients with dementia are assessed for delirium at presentation
Data collection end: October 2012
41%
Number that met the criteria: 86 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Case notes that showed that an initial assessment for delirium had been carried out
Data collection end: October 2012
39%
Number that met the criteria: 3000 / 7698
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Proportion of patients who had an assessment for the presence or absence of delirium or a documented diagnosis of delirium.
Data collection end: May 2015
36.7%
Number that met the criteria: 1496 / 4846
Area covered: England and Wales
Source: Falls and Fragility Fractures Audit Programme (FFFAP) – Inpatient Falls

What was measured: Case notes that showed that an initial assessment for delirium had been carried out
Data collection end: November 2016
45%
Number that met the criteria: 4466 / 10047
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.1.2

Observe people at every opportunity for any changes in the risk factors for delirium

What was measured: Hospitals that had a formal system in place to ensure that behaviour changes associated with delerium are clinically assessed by a heathcare professional trained and competent in the management of delerium
Data collection end: October 2012
49%
Number that met the criteria: 103 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Hospitals that had a formal system in development to ensure that behaviour changes associated with delerium are clinically assessed by a heathcare professional trained and competent in the management of delerium
Data collection end: October 2012
43.3%
Number that met the criteria: 91 / 210
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Patients who, based on the case notes, had experienced delirium, who were subsequently assessed by a healthcare professional
Data collection end: October 2012
85.7%
Number that met the criteria: 1497 / 1747
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.

What was measured: Patients who based on the case notes had experienced delirium who were subsequently assessed by a healthcare professional
Data collection end: November 2016
85%
Number that met the criteria: 2220 / 2603
Area covered: National
Source: Royal College of Psychiatrists. National Audit of Dementia.


Recommendation: 1.5.1

If indicators of delirium are identified, carry out a clinical assessment based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria or short Confusion Assessment Method (short CAM) to confirm the diagnosis. In critical care or in the recovery room after surgery, CAM‑ICU should be used. A healthcare professional who is trained and competent in the diagnosis of delirium should carry out the assessment. If there is difficulty distinguishing between the diagnoses of delirium, dementia or delirium superimposed on dementia, treat for delirium first.

What was measured: Proportion of intensive care unit patients who received an CAM-ICU screening tool assessment.
Data collection end: August 2012
33%
Data collection end: February 2013
73%
Area covered: Local
Source: Poon, ASK. and Hearn M. (2013) The effect of education on compliancy to CAM-ICU screening in intensive care unit. Intensive care medicine. Conference S487.



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