In this article, delirium as defined by the Society for Critical Care Medicine is “a syndrome characterized by the acute onset of cerebral dysfunction with a change or fluctuation in baseline mental status, inattention, and either disorganized thinking or an altered level of consciousness.” The APA Practice Guideline for the Treatment of Patients with Delirium describes 3 ‘essential features’ of delirium: 1 – Disturbance of consciousness, 2 – Change in cognition and 3 – Disturbance developing over a short period of time (and fluctuating during the course of the day). Another definition says “Delirium is basically inattention and confusion that represents the brain temporarily failing. A person who is delirious is unable to think clearly and can’t make sense of what is going on around him”. Although these definitions and features may be somewhat familiar, delirium can be hard to recognize. Many may be surprised to learn that a significant number (if not most as this article indicates) of persons with delirium are actually hypoactive (e.g., a quiet patient in bed) vs. the hyperactive form (e.g., Delirium Tremens) that might first come to mind. For this reason, the article recommends the use of delirium screens such as the Confusion Assessment Method (CAM) and the Intensive Care Delirium Screening Checklist (ICDSC). Although delirium is not thought to be completely preventable, early recognition can decrease its intensity and duration. And for those that are not prevented, understanding the underlying cause will lead to the most effective treatment. Antipsychotic medications may not always be the best intervention (e.g., for delirium resulting from an underlying medical conditions). In fact, too much/many medications can be a cause, leading one author in this article to suggest that “…the main pharmacological treatment for delirium is to reduce over medication”. The point is also made that restraints should be used very judiciously.
Tip1: Make Delirium part of this year’s annual training to encourage clinical staff (physicians and nurses in particular) to refresh and/or become more familiar with the signs and symptoms.
Tip2: Ask Psychology and/or the P&T committee to review and consider use of the CAM or ICDSC for high risk (e.g., elderly) patients.