Preventing delirium and managing cognitive impairment
People with cognitive impairment who are admitted to hospital are at a significantly increased risk of preventable complications such as falls, pressure injuries, delirium as well as adverse outcomes. Cognitive impairment should always be investigated to see whether it may be delirium as the causes may be treatable.
Ultimately, regardless of the underlying cause, screening for cognitive impairment at the first point of contact is vital to enable the development of a person centred care plan and to implement appropriate care strategies to minimise the risk of functional decline and deliver care in a way that is safe for the patient and health staff.
SA Health resources
- SA Health Comprehensive Care of Older People Model of Care
- SA Health Delirium Consumer brochure
- Medical Record form for the 4AT screen for dementia or delirium
National Safety and Quality Service Standard 5: Comprehensive Care
The NSQHS Standard 5: Comprehensive Care describes actions that need to be met for accreditation:
5.29 The health service organisation providing services to patients who have cognitive impairment or are at risk of developing delirium has a system for caring for patients with cognitive impairment to:
- Incorporate best-practice strategies for early recognition, prevention, treatment and management of cognitive impairment in the care plan, including the Delirium Clinical Care Standard10, where relevant
- Manage the use of antipsychotics and other psychoactive medicines, in accordance with best practice and legislation.
5.30 Clinicians providing care to patients who have cognitive impairment or are at risk of developing delirium use the system for caring for patients with cognitive impairment to:
- Recognise, prevent, treat and manage cognitive impairment
- Collaborate with patients, carers and families to understand the patient and implement individualised strategies that minimise any anxiety or distress while they are receiving care.
Screening for delirium and cognitive impairment
The 4AT is a screening tool designed for rapid assessment of delirium and cognitive impairment. It is a short and practical tool that is designed for rapid assessment when delirium and/or cognitive impairment is suspected. The tool should be used at first contact with a patient and at other times during an admission to identify a decline in a patient’s cognition.
Consumer information about delirium
The following resources have been developed to provide more information to consumers and their families about delirium. Health care providers are encouraged to use the consumer material to engage consumers and their families in the recognition and management of delirium.