About this toolkit

This app and website are based on SIGN Guideline 157- Risk Reduction and Management of Delirium. The app and website present current evidence for best practice in the detection, assessment, treatment and follow up of adults with delirium, as well as reducing the risk of delirium. The app and website include good practice guidance from the British Geriatrics Society on the management of delirium in patients with confirmed or suspected delirium.

The app and website are for use by health and care practitioners of all disciplines in all settings involved in the care of patients at risk of, or experiencing, delirium, and will be of interest to patients and carers. Target audiences include : primary and secondary healthcare professionals, home, community and long-term care, hospital, and hospice.

Much of the supporting evidence is in acute care settings. This does not preclude application of the recommendations to other settings, adapted according to clinician judgement. Person-centred care should be the focus of implementation.

The guidance on which the app and website are based excludes delirium secondary solely to alcohol and illicit substances use. It also excludes delirium in children.

The application is available as a website and as downloadable mobile applications, via the following link:

Online http://signdecisionsupport.uk

This software is an informational and educational resource. It is not a medical device as defined by the Medical Devices Directive.

This app and website have been developed to provide health and care practitioners with quick and easy access at point of care to evidence-based recommendations, practical tools and learning resources, to screen patients for delirium, reduce risk of delirium emerging, and manage patients with delirium.

This quick and easy access to tools to support risk reduction and management of delirium is important because delirium is among the most common of medical emergencies.  A UK study found a prevalence of 20% in adult acute general medical patients.⁵  The prevalence is higher in particular clinical groups, such as patients in intensive care units (ICU). It affects up to 50% who have hip fracture and up to 75% in intensive care.¹

Despite its importance, there are deficiencies in care of people with delirium in Scotland.  It is underdiagnosed,⁷ and the treatment of patients with established delirium is variable.  Preventative measures can reduce the incidence of delirium,¹ yet few clinical units have formal delirium risk reduction programmes.

Common concerns raised by patient groups and through research into patient and carer issues identified good communication with family members or carers as crucial.

In the context of the COVID-19 pandemic, delirium is important because (a) delirium may be a symptom at presentation and/or during management, and (b) the behavioural changes commonly seen in delirium, particularly agitation, may make management including delivery of care and reducing the risk of cross-infection more challenging.

During the coronavirus pandemic, the British Geriatrics Society (BGS) noted reports of some difficulty in managing patients with delirium testing positive with COVID-19.  This app and website incorporates the BGS consensus advice produced in collaboration with the European Delirium Association and the Old Age Psychiatry Faculty (Royal College of Psychiatrists).

Authorship

The content in this toolkit has been developed by the SIGN guideline group for SIGN 157: Risk reduction and management of delirium. 

Review and approval

Content has been reviewed and approved in line with the SIGN editorial governance process.

Final content was signed off by the SIGN Programme Lead.

The content will be considered for update 3 years from publication. Any minor updates brought to the  attention will be dealt with on an as needed basis.

Updates will be reviewed and approved in line with the SIGN editorial governance process.

Content will be updated using the guideline development processes outlined in the SIGN methodology manual, SIGN 50: a guideline developer's handbook.

The SIGN team will also monitor for any updates to the British Geriatrics Society Good Practice Guide, published in March 2020, and will update the app/website as required.

SIGN (Scottish Intercollegiate Guidelines Network): SIGN was formed in 1993.  Its objective is to improve the quality of health care for patients in Scotland by reducing variation in practice and outcome, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.

The membership of SIGN includes all the medical specialties, nursing, pharmacy, dentistry, professions allied to medicine, patients, health service managers, social services, and researchers. The work of SIGN is supported by an Executive.

SIGN is part of the Evidence Directorate of Healthcare Improvement Scotland and core funding from Healthcare Improvement Scotland supports the SIGN Executive, and expenses and costs associated with guideline development projects. SIGN is editorially independent from Healthcare Improvement Scotland and the Scottish Government which ultimately funds Healthcare Improvement Scotland.

The British Geriatrics Society (BGS) is the membership association for professionals specialising in the healthcare of older people across the UK.  The BGS provides the good practice guide which forms part of this website: Coronavirus: managing delirium in confirmed and suspected cases .

The Scottish Delirium Association (SDA) is a group of health professionals from across Scotland who share an interest in developing a better understanding of delirium, with a focus on using a collaborative approach to raise awareness of the condition within health services and to promote best practice in risk reduction, diagnosis and management. ​ The SDA is made up of a wide range of healthcare professionals, including psychiatrists, nurses, staff, physiotherapists, occupational therapists, pharmacists, and staff from Healthcare Improvement Scotland.

Professor Alasdair MacLullich: Professor of Geriatric Medicine, University of Edinburgh and NHS Lothian, has provided clinical leadership and guidance to development of this resource.

Digital Health and Care Institute (DHI): The Digital Health and Care Institute is a health and care innovation centre. It is funded jointly by Scottish Government Digital Health and Care and the Scottish Funding Council.  DHI plays a pivotal role in inspiring, enabling and combining industry and academic expertise with service, business and technical innovation to create person-centred digital health and care innovations.  DHI focuses on shifting the balance of care from a traditional treatment model, through the development of digital health and care innovations that focus on prevention, early detection, post event care and independent assisted living.

DHI leads and manages the National Decision Support Programme on behalf of Scottish Government, as a core objective within Scotland’s Digital Health and Care Strategy.  The app and website have been built using the Right Decision Service tools which DHI has developed as a key deliverable for the national programme.

The Right Decision Service now sits within the Evidence Directorate of Healthcare Improvement Scotland.

NHS Greater Glasgow and Clyde Library Network:  The NHSGGC Library Network provides library and information services to all staff working within NHSGGC and its partner organisations.

As part of the National Decision Support Programme, NHSGGC Knowledge Services provided knowledge management expertise to support use of Right Decision Service tools.

Tactuum Ltd: Tactuum is a software company based in Glasgow, with an office in the US.  Tactuum’s mission is to improve healthcare services through the delivery of digital services supporting healthcare providers and patients.  Tactuum provides the technology and digital expertise to deliver Right Decision Service tools for the National Decision Support Programme.

The content within this app/website is based on current evidence and best practice, however it is intended to be applied alongside sound clinical judgement.  As such, Healthcare Improvement Scotland is not responsible or liable for any diagnosis or management decision made on the basis of the information provided via this app/website.

Use of this app within patient care settings should always be in accordance with local policies and guidance with regard to clinical practice and mobile device usage.

Healthcare Improvement Scotland is not responsible for the content of any external websites listed, nor do they endorse any commercial product or service mentioned or advised on in any of these websites.

All use of this resource is subject to Scots law and the jurisdiction of the Scottish courts and is subject to this disclaimer.  Any views given on the app/website are not necessarily those of Healthcare Improvement Scotland or anyone connected with us.

Copyright information for the two sources of content within this app/website is shown below.

1) Scottish Intercollegiate Guidelines Network (SIGN).  SIGN 157: Risk Reduction and Management of Delirium.  Edinburgh: SIGN; 2019. [cited 20 Jun 2020]  Available from: 

https://www.sign.ac.uk/assets/sign157.pdf.

Copyright of this guideline is retained by SIGN. Users may download or print copies for their own use and may photocopy guidelines for the purpose of implementation.

This review is licensed under the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International Licence.  This allows for the copy and redistribution of SIGN guidelines as long as SIGN is fully acknowledged and given credit.  The material must not be remixed, transformed or built upon in any way.  To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc-nd/4.0/.

Please cite the guideline as: Scottish Intercollegiate Guidelines Network (SIGN). Guideline title. Edinburgh: SIGN; Year. [cited dd mmm yyyy]. Available from URL: http://www.sign.ac.uk.

Users wishing to use reproduce or republish SIGN material for commercial purposes must seek prior approval for reproduction in any medium by completing the form at https://www.sign.ac.uk/assets/sign_copyright_request.pdf.  Applicants for such permission should be aware that:

• SIGN resources do not endorse specific products
• Reproduction of SIGN material must be verbatim
• Within marketing material there must be a clear separation between any SIGN material and product specific information or marketing
• SIGN does not endorse in any way derivative or excerpted materials based on these guidelines, and it cannot be held liable for the content or use of any such adapted products
• The use of the SIGN name or logo for the purposes of advertising or implied endorsement of any derived product or service is strictly forbidden.

2) British Geriatrics Society

Intellectual Property Rights and copyright information for British Geriatrics Society content is available at https://www.bgs.org.uk/terms-of-use.