Diagnosis, prevention, and management of delirium: summary of NICE guidance

Young, John; Murthy, Lakshmi; Westby, Maggie J; Akunne, Anayo Fidelis; O’Mahony, Rachel

doi:10.1136/bmj.c3704

Cited by 269 publications

(194 citation statements)

References 5 publications

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“…[1][2][3][4] Given that delirium is associated with increased mortality, a longer duration of mechanical ventilation, and the potential for serious sequelae after leaving the ICU (eg, dementia and prolonged neuropsychological impairment), current practice guidelines recommend that patients be routinely screened by using a validated delirium screening tool such as the Intensive Care Delirium Screening Checklist (ICDSC). [5][6][7][8][9][10][11][12][13][14][15][16] However, despite an increasing awareness among ICU clinicians regarding the sequelae of delirium and the ever-increasing use of protocols for delirium screening efforts in ICUs, most patients admitted to ICUs are not routinely screened for delirium. [17][18][19][20][21][22][23] Common barriers to delirium screening with a validated tool reported by clinicians include the perceptions that the tool takes too long to complete, that use of a tool does not enhance clinicians' ability to recognize delirium, and that assessment tools are too complex to use.…”

Section: Methodsmentioning

confidence: 99%

Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly

Gesin

Russell

Lin

et al. 2012

American Journal of Critical Care

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BackgroundThe impact of using a validated delirium screening tool and different levels of education on surgical-trauma intensive care unit (STICU) nurses’ knowledge about delirium is unclear.ObjectivesTo measure the impact of using the Intensive Care Delirium Screening Checklist (ICDSC), with or without a multi-faceted education program, on STICU nurses’ knowledge and perceptions of delirium and their ability to evaluate it correctly.MethodsThe knowledge and perceptions of subject nurses about delirium, and agreement between the independent assessments of delirium by the subject nurse and by a validated judge (who always used the ICDSC), were compared across 3 phases. Phase 1: No delirium screening tool and no education. Phase 2: ICDSC and minimal education (ie, ICDSC validation study only). Phase 3: ICDSC and multifaceted education (ie, pharmacist-led didactic lecture, Web-based module, and nurse-led bedside training).ResultsNurses’ knowledge (mean [SD] score out of 10 points) was similar (P = .08) in phase 1 (6.1 [1.4]) and phase 2 (6.5 [1.4]) but was greater (P = .001) in phase 3 (8.2 [1.4]). Agreement between nurses and the validated judge in the assessment of delirium increased from phase 1 (κ = 0.40) to phase 2 (κ = 0.62) to phase 3 (κ = 0.74). Nurses perceived use of the ICDSC as improving their ability to recognize delirium.ConclusionsUse of a multifaceted education program improves both nurses’ knowledge about delirium and their perceptions about its recognition. Implementation of the ICDSC improves the ability of STICU nurses to evaluate delirium correctly.

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Section: Methodsmentioning

confidence: 99%

Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly

Gesin

Russell

Lin

et al. 2012

American Journal of Critical Care

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“…National Institute for Health and Care Excellence (NICE) guidelines recommend early identification of patients who are vulnerable as a result of non-modifiable risk factors, which lower the threshold for developing delirium (Box 1). 9 Dementia is the most significant of these and the more advanced the dementia, the higher the risk. 10 Dementia can be identified on admission with a high degree of accuracy (C-statistic 0.93) 11 using the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE).…”

Section: Identify Baseline Functionmentioning

confidence: 99%

“…Therefore, alongside cognitive tests, NICE guidelines recommend daily assessment of perception, and physical and social behaviour. 9 Perception can be measured by checking orientation to time, place and person, as well as screening for auditory and visual hallucinations.…”

Section: Suspect Delirium Earlymentioning

confidence: 99%

Delirium: a guide for the general physician

Todd¹,

Teale²

2017

Clinical Medicine

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Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. Certain predisposing factors can make an individual more susceptible to delirium in the face of a stressor. Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types.

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“…The National Institute for Health and Clinical Excellence recommends screening of all patients at high risk which includes those with any of four risk factors; namely, age ≥65 years, dementia, presentation with hip fracture and severity of illness (16). Therefore, we targeted inpatients aged ≥65 years with incurable advanced cancer and The Eastern Cooperative Oncology Group Performance Status (ECOG PS) of ≥2.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study

Uchida

Okuyama

Ito

et al. 2015

Jpn. J. Clin. Oncol.

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Objective: The aim of this study was to investigate the prevalence of delirium on admission, the course of delirium during a 2-week period after admission and factors associated with delirium on admission, among elderly patients with advanced cancer. Methods: Patients aged ≥65 years with incurable lung or gastroenterological cancer and the Eastern Cooperative Oncology Group Performance Status 2 or greater were continuously sampled after admission to a university hospital. Participants were evaluated for DSM-IV-TR delirium by trained psychiatrists and the delirium subtype was assessed using the Delirium Motor Subtype Scale within 4 days after admission and again 2 weeks later. In addition, we assessed associated factors with delirium on admission. Results: Among 73 eligible patients, complete data were available from 61 on admission and 49 after 2 weeks. Twenty-six patients (43%) met delirium criteria on admission (hypoactive: 58%, unspecified: 35%, hyperactive: 4%, mixed: 4%). Of these, 19 (73%) remained delirious 2 weeks later. Of 35 patients without delirium on admission, 21 (60%) remained delirium-free 2 weeks later and 7(20%) became delirious. Overall, 33/61 (54%) developed delirium at some point during the study. Patients receiving steroids at admission were more likely to have delirium (odds ratio = 5.0; 95% confidence interval = 1.5-16). Conclusions: Given the high prevalence of the delirium, all patients with advanced cancer should be screened for delirium both on admission and regularly thereafter. In addition, medical staff should be aware that steroid use on admission is an additional indicator of elevated risk for delirium.

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Diagnosis, prevention, and management of delirium: summary of NICE guidance

Cited by 269 publications

References 5 publications

Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly

Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly

Delirium: a guide for the general physician

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study

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