Recommendation

Healthcare professionals should follow established pathways of good care to manage patients with delirium.

• First consider acute, life-threatening causes of delirium, including low oxygen level, low blood pressure, low glucose level, and drug intoxication or withdrawal
• Systematically identify and treat potential causes (medications, acute illness, etc), noting that multiple causes are common
• Optimise physiology, management of concurrent conditions, environment (reduce noise), medications, and natural sleep, to promote brain recovery
• Specifically detect, assess causes of, and treat agitation and/or distress, using nonpharmacological means only if possible (see pharmacological treatment)
• Communicate the diagnosis to patients and carers, encourage involvement of carers, and provide ongoing engagement and support
• Aim to prevent complications of delirium such as immobility, falls, pressure sores, dehydration, malnourishment, isolation
• Monitor for recovery and consider specialist referral if not recovering
• Consider follow up.

Good practice point

• Promote cognitive engagement, mobilisation, and other rehabilitation strategies.

Advice on information to provide to family and carers, and suggestions of ways to help.  Booklets are available through the SIGN website.

See the evidence base in section 6 of SIGN 157 here