A patient at risk of delirium is offered a set of interventions to prevent delirium and regular monitoring for changes in behaviour, cognition and physical condition. Indicator 3a: Evidence of local arrangements for implementing interventions to prevent delirium for patients Definitional attributes Name: Evidence of local arrangements for implementing interventions to prevent delirium for at-risk patients Rationale: Delirium may be prevented in more than one-third of patients.1 Multicomponent interventions reduce the incidence of delirium and may prevent complications, such as falls.1 Regular monitoring of patients at risk of delirium for changes in behaviour, cognition and physical condition can assist the prompt detection of delirium.2 Collection and usage attributes Computation: Documented evidence of local arrangements for implementing interventions for patients identified as being at risk of developing delirium. Interventions found to be effective in preventing delirium that may be documented in the local protocol include:2,3 medication review correction of dehydration/ malnutrition/constipation mobility activities oxygen therapy pain assessment and management regular reorientation and reassurance activities for stimulating cognition non-drug measures to help promote sleep assistance for patients who usually wear hearing or visual aids. These interventions should be tailored to individuals depending on the individual’s clinical risk factors and the setting.3,4 The local arrangements should provide for tailored interventions. They must include a process for documenting the interventions and discussing with the patient and/or their carer the interventions being put in place. They must also include encouraging carers to be involved (e.g. providing orientation and reassurance to the patient). Numerator: N/A Numerator criteria: N/A Denominator: N/A Denominator criteria: N/A Setting: Hospital Comments: This indicator has been sourced from the Key principles for care of confused hospitalised older persons5 and Delirium NICE Quality Standard 63.6
Indicator 5b: Proportion of patients with delirium assessed for risk of falls and pressure injuries Definitional attributes Name: Proportion of patients with delirium assessed for risk of falls and pressure injuries. Rationale: Patients with delirium are at greater risk of adverse events, including falls1,2,3 and pressure injuries.2,3 Collection and usage attributes Computation: (Numerator ÷ denominator) x 100 Numerator: Number of patients with delirium assessed for risk of falls and pressure injuries. Numerator criteria: Inclusions Patients with delirium assessed for risk of falls and pressure injuries. Assessment should be systematic, based on a local assessment tool, and documented in the patient’s medical record. Exclusions Nil Denominator: Number of patients with delirium. Denominator criteria: Nil Setting: Hospital Comments: This indicator has been sourced from the Key principles for care of confused hospitalised older persons.4 References Travers C, Byrne G, Pachana N, Klein K, Gray L. Delirium in Australian hospitals: a prospective study. Current Gerontology and Geriatrics Research. 2013;ArticleID:284780. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. The Lancet. 2014;383(9920):911–22. Maher S, Almeida O. Delirium in the elderly: another medical emergency. Current Therapeutics. 2002;43(3):39–45. Agency for Clinical Innovation. Key principles for care of confused hospitalised older persons. Sydney: Agency for Clinical Innovation; 2014. Indicator 5c: Proportion of patients with delirium who have had a fall or a pressure injury during their hospital stay