Quality statement 2: Interventions to prevent delirium

Quality statement

Adults newly admitted to hospital or long-term care who are at risk of delirium receive a range of tailored interventions to prevent delirium.

Rationale

Delirium is potentially preventable, and interventions can be effective in preventing delirium in adults who are at risk. These preventative measures should be tailored to each person's needs, based on the results of an assessment for clinical factors that may contribute to the development of delirium. Such clinical factors include cognitive impairment, disorientation, dehydration, constipation, hypoxia, infection or other acute illness, immobility or limited mobility, pain, effects of medication, poor nutrition, sensory impairment and sleep disturbance.

Quality measures

Structure

Evidence of local arrangements to ensure that adults newly admitted to hospital or long-term care who are at risk of delirium receive a range of tailored interventions to prevent delirium.

Data source: Local data collection.

Process

a) Proportion of adults newly admitted to hospital or long-term care who are at risk of delirium who are assessed for clinical factors that may contribute to the development of delirium within 24 hours of their admission.

Numerator – the number in the denominator who are assessed for clinical factors that may contribute to the development of delirium within 24 hours of their admission.

Denominator – the number of adults newly admitted to hospital or long-term care who are at risk of delirium.

Data source: Local data collection. NICE clinical guideline 103 audit support, criterion 3.

b) Proportion of adults newly admitted to hospital or long-term care who are at risk of delirium who receive a range of tailored interventions to prevent delirium.

Numerator – the number in the denominator who receive a range of tailored interventions to prevent delirium.

Denominator – the number of adults newly admitted to hospital or long-term care who are at risk of delirium who have an assessment for clinical factors that may contribute to the development of delirium.

Data source: Local data collection.

Outcome

Incidence of delirium.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (such as hospitals, residential care homes, nursing homes) ensure that guidance is available on using a range of tailored interventions to prevent delirium.

Health and social care practitioners ensure that adults newly admitted to hospital or long-term care who are at risk of delirium receive a range of tailored interventions to prevent delirium.

Commissioners (such as clinical commissioning groups [CCGs], local authorities) ensure that the hospitals and long-term care they commission services from can demonstrate (for example, by auditing current practice) the use of a range of tailored interventions to prevent delirium. CCGs may include this in local Commissioning for Quality and Innovation (CQUIN) targets for improving dementia and delirium care.

What the quality statement means for patients, service users and carers

Adults admitted to hospital or to a residential care home or nursing home who are thought to be at risk of delirium are assessed and offered care to reduce their chances of getting delirium that takes into account their particular needs and circumstances.

Source guidance

  • Delirium (NICE clinical guideline 103), recommendations 1.3.2 (key priority for implementation) and 1.3.3.1 to 1.3.3.10.

Definitions of terms used in this quality statement

Long-term care

Residential care provided in a home that may include skilled nursing care and help with everyday activities. This includes nursing homes and residential homes. [NICE clinical guideline 103, full guideline, glossary of terms]

Adults at risk of delirium

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. 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). [NICE clinical guideline 103, recommendation 1.1.1]

Tailored interventions to prevent delirium

Interventions to prevent delirium are provided by a multidisciplinary team and are tailored to the care setting and to the person's individual needs. They are based on the results of an assessment for clinical factors that may contribute to the development of delirium, including cognitive impairment, disorientation, dehydration, constipation, hypoxia, infection or other acute illness, immobility or limited mobility, pain, effects of medication, poor nutrition, sensory impairment and sleep disturbance. Interventions could include:

  • avoiding moving people within and between wards or rooms unless absolutely necessary

  • ensuring that the person is cared for by a team of healthcare professionals who are familiar to them

  • providing appropriate lighting and clear signage; for example, a 24‑hour clock, a calendar

  • talking to the person to reorientate them

  • introducing cognitively stimulating activities

  • if possible, encouraging regular visits from family and friends

  • ensuring that the person has adequate fluid intake

  • looking for and treating infections

  • avoiding unnecessary catheterisation

  • encouraging the person to walk or, if this is not possible, to carry out active range-of-motion exercises

  • reviewing pain management

  • carrying out a medication review

  • ensuring that the person's dentures fit properly

  • ensuring that any hearing and visual aids are working and are used

  • reducing noise during sleep periods

  • avoiding medical or nursing interventions during sleep periods.

[Adapted from NICE clinical guideline 103, recommendations 1.3.1 and 1.3.3.1 to 1.3.3.10]

Equality and diversity considerations

A learning disability specialist nurse should be involved in providing tailored interventions aimed at preventing delirium for adults with a learning disability who are at risk, to ensure that the person's specific needs are taken into account.