Delirium secondary prevention: Difference between revisions

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Revision as of 05:31, 17 February 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Khurana, M.B.B.S., M.D. [2]

Overview

Prevention of complications The main complications of delirium are :

Falls
Pressure sores
Nosocomial infections
Functional impairment
Continence problems
Over sedation

Falls

Restraints are not effective in preventing falls but ironically restrain may increase the risk of injury. Patient should be bedded on the floor or closer to the floor.

Pressure sores

The following strategies may be utilized to prevent and manage pressure sores,

Formal pressure sore risk assessment ( eg Norton score, or Waterlow score)
Regular pressure area care, including special mattresses where necessary
Mobilization as soon as their illness allows.

Functional impairment

Physiotherapist and occupational therapist consult is beneficial to maximize recovery.

Continence

Issues related to continence may be managed by following guidelines,

Continence assessment
Regular toiletting
Prompt treatment of UTI
Avoid catheters as it may elevate risks of trauma in confused patients, and also UTIs.

References

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@@ Line 4: / Line 4: @@
 ==Overview==
-Prevention of complications
+'''Prevention of complications'''
 The main complications of delirium are :
+* Falls
-·                     Falls
+* Pressure sores
+* Nosocomial infections
-·                     Pressure sores
+* Functional impairment
+* Continence problems
-·                     Nosocomial infections
+* Over sedation
+===Falls===
-·                     Functional impairment
+Restraints are not effective in preventing falls but ironically restrain may increase the risk of injury.  Patient should be bedded on the floor or closer to the floor.
+===Pressure sores===
-·                     Continence problems
+The following strategies may be utilized to prevent and manage pressure sores,
+* Formal pressure sore risk assessment ( eg Norton score, or Waterlow score)
-·                     Over sedation
+* Regular pressure area care, including special mattresses where necessary
+* Mobilization as soon as their illness allows.
-Restraints (including cotsides, "geriatric chairs" etc.) have not been shown to prevent falls and may increase the risk of injury [37‑39]. It may be preferable to nurse the patient on a low bed or place the mattress directly on the floor. Adoption of the good practices described should make the use of physical restraints unnecessary for the management of confusion (grade III).
+===Functional impairment===
+Physiotherapist and occupational therapist consult is beneficial to maximize recovery.
-Pressure sores
+===Continence===
+Issues related to continence may be managed by following guidelines,
-Patients should have a formal pressure sore risk assessment ( eg Norton score, or Waterlow score), and receive regular pressure area care, including special mattresses where necessary (grade III). Patients should be mobilised as soon as their illness allows.
+* Continence assessment
+* Regular toiletting
-Functional impairment
+* Prompt treatment of UTI
+* Avoid catheters as it may elevate risks of trauma in confused patients, and also UTIs.
-Assessment by a physiotherapist and occupational therapist to maintain and improve functional ability should be considered in all delirious patients (grade III). There is evidence that patients who are managed by a multidisciplinary team do better than those cared for in a traditional way [18, 23, 25‑26, 33‑35] (grade I, IIb).
-Continence
-A full continence assessment should be carried out. Regular toiletting and prompt treatment of UTI`s may prevent urinary incontinence. Catheters should be avoided where possible because of the increased risks of trauma in confused patients, and the risk of catheter associated infection (grade III).
-Referral to Old Age Psychiatry services
-Many patients with delirium have an underlying dementia which may be best followed up and managed by an Old Age Psychiatrist. Patients who fail to improve despite adequate treatment and resolution of the suspected cause of the delirium may benefit from referral to an Old Age Psychiatrist for further assessment (grade III) [35].
-Discharge
-As with all elderly patients discharge should be planned in conjunction with all disciplines involved in caring for the patient, both in hospital and in the community (including informal carers). Practical arrangements should be in place prior to discharge for activities such as washing, dressing, medication etc.in accordance with the joint statement of the British Geriatrics Society and the Association Directors of Social Services [43] (grade III).
-·                     Communication with all parties involved in the patients care is vital.
-·                     Prior to discharge it is useful to assess the patients cognitive and functional status ( eg using standardised tools such as AMT and Barthel Index).
-·                     Discharge summaries should be completed promptly.
-Follow up
-Delirium is a common first presentation of an underlying dementing process. It may also be a marker of severe illness and comorbidity. It is therefore often appropriate to refer the patient to a Geriatrician, Psychiatrist of Old Age, CPN or Social Worker for the Elderly or Consultant in Geriatric Medicine for further assessment and follow up.
 ==References==
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