Palliative and end of life care (Care homes & care at home)
Check the environment to ensure that you, the client and those close to them are safe. Remove objects that are a potential hazard, such as knives, cigarette lighters and electrical cords.
Soothe and address anxiety. Clients with delirium are often frightened.
Ensure glasses, hearing aids etc. are close to hand.
Gently and regularly re-orientate the client. Provide visual clues for the time and date, such as a clocks and newspapers.
Try to keep the environment calm and quiet. Minimise noise. If possible, limit the number of people around the client at any one time.
Avoid confrontation.
Try to keep the person in a normal sleep wake pattern by using lights at the appropriate times, reducing noise and stimulation at night. Encourage getting up at the usual time.
Encourage fluid and dietary intake as far as possible.
Explain the cause of the client’s behaviour to relatives and carers and give reassurance.
Check the person’s care plan – or ask healthcare colleagues to do so - to see if they have made any advance wishes about care and treatment they would and would not like to have if they delirium.
Communicate clearly and be consistent when you’re talking to the client.
If you don’t speak the patient’s language, arrange through the healthcare team to have an interpreter.
Delirium will usually require medical and nursing support and medication. Contact your GP, District Nurse or Coordinator if there is a sudden onset of delirium /acute confusion while you are with the client and they are not already receiving treatment.
You may want to use the 4AT Delirium Screening Tool in the Assessment and Management Toolkit to check for likelihood of delirium.