Materiały źródłowe

• #1 Recognising and preventing delirium | Quick guides to social care topics | Social care | NICE Communities | About | NICE

  https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/recognising-and-preventing-delirium

  Delirium is preventable in 30% of cases. […] To help prevent delirium in anyone at risk: Make sure support is provided by carers who are familiar to them. […] Avoid moving the person unnecessarily, and keep their surroundings familiar. […] Request a review if they are taking multiple medications. […] Check on admission, and then daily, for any changes that might indicate delirium and refer for an assessment if needed. […] Factors that make delirium more likely are listed below, with steps to help reduce the risk. […] Encourage the person to drink. […] Support the person to avoid or address constipation. […] Make sure pain is well-managed. […] Look for signs of infection. […] Avoid using a catheter as far as possible. […] Make sure any dentures are clean, being worn and fit well. […] Avoid disturbing the person during sleep periods.

• #2 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium can often be prevented and can be treated and managed. […] Delirium is preventable in 30-40 per cent of cases. […] There are many things we can do to help older people and their families and carers understand, prevent and manage delirium. Here are some recommendations. […] Reducing, ceasing or avoiding the use of psychoactive drugs is recommended as they may worsen the delirium. […] Pharmacological therapy should only be considered in severe cases of behavioural or emotional disturbance because there is no strong evidence they effectively improve prognosis. […] Always document the indications for using and stopping use of antipsychotic medication in the patient’s medical history. […] Review the use and effectiveness of any medications regularly by monitoring the patient for over-sedation, postural hypotension and Parkinsonism.

• #3 Delirium prevention: Up close and personal – Healthy Debate

  https://healthydebate.ca/2023/05/topic/delirium-prevention/

  Delirium is a sudden change in attention and thinking ability caused by an underlying medical condition. […] Delirium can be treated and prevented. […] Prevention is more straightforward; in fact, 30 to 40 per cent of hospital acquired delirium can be prevented with non-drug tactics. […] These preventive measures are also extremely accessible and can be led by families, caregivers and health-care workers alike.

• #4 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications. […] Be aware that people in hospital or long-term care may be at risk of delirium. This can have serious consequences (such as increased risk of dementia and/or death) and, for people in hospital, may increase their length of stay in hospital and their risk of new admission to long-term care. […] Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary.

• #5 Delirium: Prevent, Identify, Treat | ANA Enterprise

  https://www.nursingworld.org/practice-policy/work-environment/health-safety/delirium/

  Delirium is an acute, serious, and often preventable, medical condition characterized by confusion and a disturbed thought process, often following assault to the body such as surgery, infection, dehydration, or certain medications. […] Delirium is associated with many adverse outcomes which include: increased mortality, falls, functional decline, cognitive impairment and decline and significant costs. […] Since frontline nurses are in direct contact with patients 24 hours per day and seven days a week, RNs need to drive delirium prevention. The best prevention protocol simply consists of high-level nursing care. […] An interdisciplinary approach to prevent, manage, and treat delirium is essential. […] This American Geriatrics Society (AGS) clinical practice guideline was developed to identify evidence-based pharmacological and non-pharmacological strategies that should be implemented in the perioperative period for the prevention and treatment of postoperative delirium in older patients who are identified as at risk for delirium with delirium risk prediction models.

• #6 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium.

• #7 Delirium and acute confusional states: Prevention, treatment, and prognosis – UpToDate

  https://www.uptodate.com/contents/delirium-and-acute-confusional-states-prevention-treatment-and-prognosis

  Delirium and acute confusional states: Prevention, treatment, and prognosis […] The management of delirium is based primarily upon expert consensus and observational studies, and only a small number of controlled clinical trials, which are difficult to perform in patients with cognitive impairment. The preponderance of evidence is most compelling for primary prevention of delirium using nonpharmacologic, multicomponent approaches targeted broadly at high-risk patients. […] Prevention and therapy of delirium are based on the following principles: […] Avoiding factors known to cause or aggravate delirium, such as multiple medications, dehydration, immobilization, sensory impairment, and disruption of the sleep-wake cycle […] Identifying and treating the underlying acute illness.

• #8 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  In people in hospital who are at high risk of delirium, which medication (atypical antipsychotics, typical antipsychotics, benzodiazepines or acetylcholinesterase inhibitors), compared with placebo or each other, is more clinically and cost effective in preventing the development of delirium? […] Although there is moderate-quality evidence of clinical and cost effectiveness for multicomponent interventions for the prevention of delirium in people in hospital, there is no evidence in a long-term care setting. It is anticipated that such an intervention would benefit this long-term care population. […] This clinical guideline describes methods of preventing, identifying, diagnosing and treating delirium. In particular, the guideline focuses on preventing delirium in people identified to be at risk, using a targeted, multicomponent, non-pharmacological intervention that addresses a number of modifiable risk factors (clinical factors).

• #9 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium.

• #10 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium.

• #11 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #12 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #13 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #14 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Be aware that people in hospital or long-term care may be at risk of delirium. This can have serious consequences (such as increased risk of dementia and/or death) and, for people in hospital, may increase their length of stay in hospital and their risk of new admission to long-term care. […] Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary. […] Give a tailored multicomponent intervention package: within 24 hours of admission, assess people at risk for clinical factors contributing to delirium. […] The tailored multicomponent intervention package should be delivered by a multidisciplinary team trained and competent in delirium prevention.

• #15 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications. […] Be aware that people in hospital or long-term care may be at risk of delirium. This can have serious consequences (such as increased risk of dementia and/or death) and, for people in hospital, may increase their length of stay in hospital and their risk of new admission to long-term care. […] Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary.

• #16 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Be aware that people in hospital or long-term care may be at risk of delirium. This can have serious consequences (such as increased risk of dementia and/or death) and, for people in hospital, may increase their length of stay in hospital and their risk of new admission to long-term care. […] Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary. […] Give a tailored multicomponent intervention package: within 24 hours of admission, assess people at risk for clinical factors contributing to delirium. […] The tailored multicomponent intervention package should be delivered by a multidisciplinary team trained and competent in delirium prevention.

• #17 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Give a tailored multicomponent intervention package: within 24 hours of admission, assess people at risk for clinical factors contributing to delirium; based on the results of this assessment, provide a multicomponent intervention tailored to the person’s individual needs and care setting as described in recommendations 1.4.4 to 1.4.13. […] The tailored multicomponent intervention package should be delivered by a multidisciplinary team trained and competent in delirium prevention. […] Address cognitive impairment and/or disorientation by: providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk; talking to the person to reorientate them by explaining where they are, who they are and what your role is; introducing cognitively stimulating activities (for example, reminiscence); facilitating regular visits from family and friends.

• #18 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address cognitive impairment and/or disorientation by: providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk. […] Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times).

• #19 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times). […] Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties (for example, people with learning difficulties or dementia, or people on a ventilator or who have a tracheostomy); starting and reviewing appropriate pain management in any person in whom pain is identified or suspected.

• #20 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address cognitive impairment and/or disorientation by: providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk. […] Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times).

• #21 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times). […] Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties (for example, people with learning difficulties or dementia, or people on a ventilator or who have a tracheostomy); starting and reviewing appropriate pain management in any person in whom pain is identified or suspected.

• #22 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address cognitive impairment and/or disorientation by: providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk. […] Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times).

• #23 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times). […] Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties (for example, people with learning difficulties or dementia, or people on a ventilator or who have a tracheostomy); starting and reviewing appropriate pain management in any person in whom pain is identified or suspected.

• #24 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address cognitive impairment and/or disorientation by: providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk. […] Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times).

• #25 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times). […] Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties (for example, people with learning difficulties or dementia, or people on a ventilator or who have a tracheostomy); starting and reviewing appropriate pain management in any person in whom pain is identified or suspected.

• #26 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address cognitive impairment and/or disorientation by: providing appropriate lighting and clear signage; a clock (consider providing a 24-hour clock in critical care) and a calendar should also be easily visible to the person at risk. […] Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times).

• #27 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is often preventable, but most preventive measures are things only clinical personnel should do. However, family, friends and loved ones can play a very important role in reducing the risk of delirium. […] Here are some methods that healthcare providers use to prevent delirium: Regular delirium assessments: Rounding and tracking mental state can help providers catch subtle warning signs that mean delirium could develop. […] Early mobility is key. People who move around early in treatment (with medical guidance) had a lower risk of developing delirium in large clinical trials. […] Mental exercise: Keeping your brain aware of the date, time and situation, especially with calendars and clocks, can help reduce your risk of delirium. Family members and loved ones can assist with mental exercise and stimulation with the instruction of your care provider.

• #28 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Address dehydration and/or constipation by: ensuring adequate fluid intake to prevent dehydration by encouraging the person to drink; consider offering subcutaneous or intravenous fluids if necessary. […] Assess for hypoxia and optimise oxygen saturation if necessary, as clinically appropriate. […] Address infection by: looking for and treating infection; avoiding unnecessary catheterisation; implementing infection control procedures in line with the NICE guideline on healthcare-associated infections. […] Address immobility or limited mobility through the following actions: Encourage people to mobilise soon after surgery; walk (provide appropriate walking aids if needed; these should be accessible at all times). […] Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties (for example, people with learning difficulties or dementia, or people on a ventilator or who have a tracheostomy); starting and reviewing appropriate pain management in any person in whom pain is identified or suspected.

• #29 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties; starting and reviewing appropriate pain management in any person in whom pain is identified or suspected. […] Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods.

• #30 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods. […] The guideline committee has made the following key recommendations for research.

• #31 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties; starting and reviewing appropriate pain management in any person in whom pain is identified or suspected. […] Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods.

• #32 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods. […] The guideline committee has made the following key recommendations for research.

• #33 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties; starting and reviewing appropriate pain management in any person in whom pain is identified or suspected. […] Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods.

• #34 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods. […] The guideline committee has made the following key recommendations for research.

• #35 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties; starting and reviewing appropriate pain management in any person in whom pain is identified or suspected. […] Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods.

• #36 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods. […] The guideline committee has made the following key recommendations for research.

• #37 Recommendations | Delirium: prevention, diagnosis and management in hospital and long-term care | Guidance | NICE

  https://www.nice.org.uk/guidance/cg103/chapter/1-guidance

  Address pain by: assessing for pain; looking for non-verbal signs of pain, particularly in those with communication difficulties; starting and reviewing appropriate pain management in any person in whom pain is identified or suspected. […] Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods.

• #38 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Loved ones can play a significant role in preventing and addressing delirium for someone in a medical setting. The goal is to keep your loved one engaged and anchored to the world around them. […] Social interactions with family, friends and other loved ones can be a major help in preventing delirium.

• #39 Delirium Prevention in Older Adults with the Hospital Elder Life Program | Hebrew SeniorLife

  https://www.hebrewseniorlife.org/blog/delirium-prevention-older-adults-hospital-elder-life-program

  Everyone knows that a hospital visit can be stressful for even the healthiest person. But what you may not know, is that many patients – seniors especially – can be severely affected by the stress of a hospital visit or stay, and can often end up displaying signs of delirium. […] The good news is, in many cases, there are relatively simple ways that hospital staff and family members can work together to prevent delirium. […] The goal of our work is to continue to train others in delirium prevention and how to implement HELP in order to improve outcomes for hospitalized older adults. […] Delirium is a common and serious issue that is associated with increased functional and cognitive decline, increased rates of dementia, institutionalization, and caregiver burden. […] Family members and caregivers can help prevent delirium by being present with their loved one in the hospital to alleviate anxiety of being in an unfamiliar setting.

• #40 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Loved ones can play a significant role in preventing and addressing delirium for someone in a medical setting. The goal is to keep your loved one engaged and anchored to the world around them. […] Social interactions with family, friends and other loved ones can be a major help in preventing delirium.

• #41 Expanding delirium prevention during COVID-19 with the Modified and Expanded Hospital Elder Life Program (HELP-ME) – NIDUS

  https://deliriumnetwork.org/expanding-delirium-prevention-during-covid-19-with-the-modified-and-expanded-hospital-elder-life-program-help-me/

  Delirium prevention methods were challenged by the COVID-19 pandemic. Delirium, a common complication of hospitalization for older adults, is associated with increased rates of morbidity, institutionalization, and mortality. Multiple studies have shown at least 40% of cases may be preventable using multicomponent strategies such as the Hospital Elder Life Program (HELP), the original delirium prevention model published in 1999. […] During the COVID-19 pandemic, delirium became epidemic, with prevalence rates of 25%65% reported in numerous studies. Although the need for HELP assumed even greater importance, many HELP programs had their staff redeployed, and volunteers, a key component of HELP, were not allowed in many hospitals. Thus, we designed the Modified and Extended Hospital Elder Life Program (HELP-ME), an innovative adaptation of HELP for remote and/or physically distanced purposes.

• #42 Expanding delirium prevention during COVID-19 with the Modified and Expanded Hospital Elder Life Program (HELP-ME) – NIDUS

  https://deliriumnetwork.org/expanding-delirium-prevention-during-covid-19-with-the-modified-and-expanded-hospital-elder-life-program-help-me/

  HELP-ME has the potential to broaden the reach of established multicomponent delirium prevention models and aid in improving the care of older adults. HELP-ME is feasible to implement and generally acceptable to staff and patients. Importantly, HELP-ME allowed for additional interaction that would not have otherwise been possible during the pandemic. […] In circumstances where traditional HELP is not feasible, HELP-ME may maintain access to delirium prevention resources. Considering the limitations of HELP-ME, the expert sites recommended a hybrid approach combining remote and in-person protocols, which could be used for patients in isolation or when staffing is inadequate.

• #43 Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study | BMC Nursing | Full Text

  https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-022-01019-5

  Our study findings showed a strict visitation policy hindered family engagement, though previous studies reported that family engagement was one of the most important interventions for delirium prevention. […] This study highlights the importance of adopting case-based teaching and learning in delirium training. […] A previous study also reported that nurses provided insufficient support to patients who needed glasses/hearing aids, family caregivers did not bring needed items to the ICU, and some patients refused to use them. […] Despite the lack of structured sensory stimulation, participants in this study widely discussed the benefits of implementing feasible methods, including involving a familiar person, preparing family photographs and records, and employing communication techniques, within the ICU environment. […] Therefore, such structured sensory stimulation programs with family involvement could contribute to delirium prevention. […] Implementing management strategies to effect changes in ICUs are needed to enhance and sustain the implementation of non-pharmacological delirium prevention practices.

• #44 Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study | BMC Nursing | Full Text

  https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-022-01019-5

  Our study aimed to explore nurses perceptions of current non-pharmacological practices for delirium prevention, including delirium screening, early mobilisation, sleep promotion, family participation, and sensory stimulation in adult ICUs. […] The implementation of non-pharmacological delirium prevention practices was limited by a strict ICU visitation policy, lack of routine delirium screening and delirium training, safety concerns during implementation, light and noise disturbances during nighttime hours, and frequent resuscitation and new admissions. […] Case-based training, adopting a sensory stimulation protocol, and family engagement may be enablers. […] Family engagement is very important for the implementation of non-pharmacological delirium prevention practices. […] Providing more delirium knowledge to family caregivers is therefore vital in enhancing their understanding of nursing care and improving family-caregiver participation.

• #45 Preventing and treating delirium in clinical settings for older adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493062/

  Prevention of delirium is most often accomplished by identifying and addressing the many vulnerabilities that increase risk for delirium. […] Prevention strategies can be divided into both nonpharmacological and pharmacological interventions, and several multi-component nonpharmacological approaches to delirium management focus on prevention. […] The most well studied are the Hospital Elder Life Program (HELP) and the ABCDEF bundle. […] A 2015 meta-analysis found that 11 studies with 4267 patients demonstrated that multi-component nonpharmacological delirium interventions reduced delirium incidence (odds ratio: 0.47; 95% CI: 0.380.58) with a number needed to treat of 14.3 (95% CI: 11.120.0). […] In contrast to the success of nonpharmacological approaches, pharmacological interventions have proven less helpful in preventing delirium.

• #46

  https://journals.lww.com/tnpj/fulltext/2023/05000/delirium_prevention_and_management_in_hospitalized.4.aspx

  There is no universal recommendation supporting the use of any kind of medication to prevent delirium. Clinicians may be tempted to use scheduled antipsychotics to prevent delirium in high-risk individuals. However, there is no evidence to support this practice except under very specific circumstances (such as routine management of schizophrenia); therefore, scheduled antipsychotics are not appropriate for delirium prevention.

• #47

  https://journals.lww.com/tnpj/fulltext/2023/05000/delirium_prevention_and_management_in_hospitalized.4.aspx

  There is no universal recommendation supporting the use of any kind of medication to prevent delirium. Clinicians may be tempted to use scheduled antipsychotics to prevent delirium in high-risk individuals. However, there is no evidence to support this practice except under very specific circumstances (such as routine management of schizophrenia); therefore, scheduled antipsychotics are not appropriate for delirium prevention.

• #48 Reddit – The heart of the internet

  https://www.reddit.com/r/medicine/comments/gzdtzp/journal_club_quetiapine_for_delirium_prophylaxis/

  Abraham et al. will be the start. Briefly, the study population is delirium in trauma patients admitted to the ICU, receiving quetiapine 12.5 q12 hours or nothing. […] Delirium was significantly less likely in the quetiapine group, 45.5% versus 77.6%, and mechanical ventilation was 1.5 versus 8.2 days. […] Our study suggests that prophylactic use of low-dose quetiapine could be helpful for the prevention of delirium in critically ill patients. Although the incidence of ICU delirium did not decrease, patients treated with quetiapine in this study experienced less fluctuation of symptoms, shorter durations of delirium, and a higher success rate of being weaned from mechanical ventilation. […] However, preventing delirium though pharmacologic agents is an attractive possibility due to the relatively simple administration of drugs compared to the implementation of non-pharmacologic interventions, such as daily awakening, early rehabilitation exercise, improving the ICU environment, and following sleep-enhancing protocols, which are more time consuming for ICU staffs. […] Overall conclusions: quetiapine appears to be safe. Quetiapine appears to be effective, confounding use of sedatives in Abraham et al. notwithstanding.

• #49 Low Dose Risperidone Prophylaxis for The Prevention of Delirium in The Intensive Care Unit: A Randomized, Placebo Controlled Trial | Published in Delirium Communications

  https://deliriumcommunicationsjournal.com/article/84092-low-dose-risperidone-prophylaxis-for-the-prevention-of-delirium-in-the-intensive-care-unit-a-randomized-placebo-controlled-trial

  Delirium is common among patients in intensive care units. Antipsychotics have been shown to reduce the incidence of delirium in post-operative patients. We set out to compare the efficacy of risperidone to placebo in preventing delirium in critically ill patients admitted to a medical ICU. […] In this study, low-dose risperidone did not prevent the incidence of delirium. As delirium is a heterogeneous syndrome, a single intervention may not be effective across subtypes and aetiologies. […] Prophylactic risperidone did not reduce the incidence of delirium in ICU patients in this small study. As delirium is a heterogeneous syndrome, a single intervention may not be effective across subtypes and aetiologies. […] Prophylactic use of risperidone did not reduce the incidence of delirium among patients admitted to the medical ICU. Further trials are required for a definitive recommendation.

• #50 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium can often be prevented and can be treated and managed. […] Delirium is preventable in 30-40 per cent of cases. […] There are many things we can do to help older people and their families and carers understand, prevent and manage delirium. Here are some recommendations. […] Reducing, ceasing or avoiding the use of psychoactive drugs is recommended as they may worsen the delirium. […] Pharmacological therapy should only be considered in severe cases of behavioural or emotional disturbance because there is no strong evidence they effectively improve prognosis. […] Always document the indications for using and stopping use of antipsychotic medication in the patient’s medical history. […] Review the use and effectiveness of any medications regularly by monitoring the patient for over-sedation, postural hypotension and Parkinsonism.

• #51 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium can often be prevented and can be treated and managed. […] Delirium is preventable in 30-40 per cent of cases. […] There are many things we can do to help older people and their families and carers understand, prevent and manage delirium. Here are some recommendations. […] Reducing, ceasing or avoiding the use of psychoactive drugs is recommended as they may worsen the delirium. […] Pharmacological therapy should only be considered in severe cases of behavioural or emotional disturbance because there is no strong evidence they effectively improve prognosis. […] Always document the indications for using and stopping use of antipsychotic medication in the patient’s medical history. […] Review the use and effectiveness of any medications regularly by monitoring the patient for over-sedation, postural hypotension and Parkinsonism.

• #52 Hospital Elder Life Program (HELP) | University of Utah Health

  https://healthcare.utah.edu/geriatrics/hospital-elder-life-program

  The Hospital Elder Life Program (HELP) is an evidence-based care program designed to prevent delirium and functional decline in hospitalized adults over 65 years old. […] Many years of clinical trials prove that this program reduces occurrences of delirium and improves patient outcomes overall. […] Delirium Prevention: Tips for Patients […] Stay oriented. Look at a calendar, clock, cell phone or newspaper to make sure you know the date and time. […] Be active. Exercise is a great way to prevent physical and mental decline. Follow the advice of your medical team for any activity restrictions. […] Notify your medical team right away if you have new confusion, disorientation, or hallucinations. […] HELP staff sends volunteers to patients who are at a high level of risk of developing delirium, based on their medical chart.

• #53 Hospital Elder Life Program (HELP) | University of Utah Health

  https://healthcare.utah.edu/geriatrics/hospital-elder-life-program

  The Hospital Elder Life Program (HELP) is an evidence-based care program designed to prevent delirium and functional decline in hospitalized adults over 65 years old. […] Many years of clinical trials prove that this program reduces occurrences of delirium and improves patient outcomes overall. […] Delirium Prevention: Tips for Patients […] Stay oriented. Look at a calendar, clock, cell phone or newspaper to make sure you know the date and time. […] Be active. Exercise is a great way to prevent physical and mental decline. Follow the advice of your medical team for any activity restrictions. […] Notify your medical team right away if you have new confusion, disorientation, or hallucinations. […] HELP staff sends volunteers to patients who are at a high level of risk of developing delirium, based on their medical chart.

• #54 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #55 Hospital Elder Life Program (HELP) | University of Utah Health

  https://healthcare.utah.edu/geriatrics/hospital-elder-life-program

  The Hospital Elder Life Program (HELP) is an evidence-based care program designed to prevent delirium and functional decline in hospitalized adults over 65 years old. […] Many years of clinical trials prove that this program reduces occurrences of delirium and improves patient outcomes overall. […] Delirium Prevention: Tips for Patients […] Stay oriented. Look at a calendar, clock, cell phone or newspaper to make sure you know the date and time. […] Be active. Exercise is a great way to prevent physical and mental decline. Follow the advice of your medical team for any activity restrictions. […] Notify your medical team right away if you have new confusion, disorientation, or hallucinations. […] HELP staff sends volunteers to patients who are at a high level of risk of developing delirium, based on their medical chart.

• #56 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #57 Preventing Delirium During Hospital Stays With Nonpharmacologic Interventions – Brigham On a Mission

  https://www.brighamhealthonamission.org/2019/11/11/preventing-delirium-during-hospital-stays-with-nonpharmacologic-interventions/

  Delirium, a sudden onset of confusion frequently seen in older patients, was once thought to be a temporary condition that patients snapped out of after being discharged from the hospital. However, it is now recognized that delirium may lead to longer-term cognitive impairment and poor health outcomes, including an increased risk of death, nursing home placement and memory problems. […] The study analyzed the effectiveness of the Hospital Elder Life Program (HELP), which focuses on nonpharmacologic delirium-prevention strategies. […] HELP is a clinically effective, cost-effective program that can help prevent delirium, said Tammy T. Hshieh, MD, MPH, one of the studys lead researchers and an associate physician with the Brighams Division of Aging. […] Those strategies include special training for nurses on assessing patients for delirium and reorienting patients every day, sometimes every shift, as to who they are, where they are, what day it is and why they are in the hospital.

• #58 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #59 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #60 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Delirium is common and increases in prevalence with age and medical complexity. Many organizations have developed clinical protocols to prevent and treat delirium and what are called cognitive-friendly policies to care for elderly patients. Although delirium is preventable in 30% to 40% of inpatient cases, it is often underrecognized and undertreated in the hospital. Cognitive-friendly policies, or evidence-based strategies to prevent and mitigate harm from delirium, have been known for over 20 years. Consensus guidelines recommend general prevention interventions, such as orientation, normalization of the environment (eg, diet, utilization of hearing aids, music), promotion of sleep/wake cycle, treatment of pain, mobilization, and avoidance of deliriogenic medications such as benzodiazepines. The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit (ICU) of the Society of Critical Care Medicine provide guidance for prevention of delirium. The ABCDEF bundle is a way to operationalize the PAD guidelines through ICU delirium prevention strategies. Adherence to this bundle is associated with a 40% reduction in likelihood of delirium on the day following exposure to the bundle. Additionally, implementation of this bundle has resulted in other clinically meaningful outcomes, such as reduced time on mechanical ventilation, time in a coma, and use of restraints. The Hospital Elder Life Program (HELP) is a targeted, multicomponent strategy to prevent functional and cognitive decline in hospitalized older persons. This bundle involves many members of the care team, as well as patients, and creates a personalized program using targeted interventions, such as daily visits, orientation, therapeutic activities, and more. The program has been shown to reduce the odds of delirium by 53%.

• #61 Medical Professionals Overview

  https://www.icudelirium.org/medical-professionals/overview

  Delirium: Assess, Prevent and Manage. There are validated tools that are recommended that can be used in every patient every day. […] The A2F bundle, in accordance with the Society of Critical Care Medicines 2018 Clinical Practice Guidelines for the Management of Pain, Agitation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult ICU Patients, must include routine pain, agitation, and delirium screening and management through the use of valid and reliable tools. […] The ABCDEF bundle is the central framework of the ICU liberation program and it helps drive those treatment decisions. […] There is a dose-response relationship between higher compliance with the ABCEDF bundle and higher survival, shorter time on mechanical ventilation, earlier discharge from the ICU and hospital, fewer bounce backs to the ICU, less delirium and coma, less use of restraints. […] The elements in the bundle help navigate towards less suffering for both patients and families and optimizing meaningful time with the people most important to our patients.

• #62 Medical Professionals Overview

  https://www.icudelirium.org/medical-professionals/overview

  Delirium: Assess, Prevent and Manage. There are validated tools that are recommended that can be used in every patient every day. […] The A2F bundle, in accordance with the Society of Critical Care Medicines 2018 Clinical Practice Guidelines for the Management of Pain, Agitation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult ICU Patients, must include routine pain, agitation, and delirium screening and management through the use of valid and reliable tools. […] The ABCDEF bundle is the central framework of the ICU liberation program and it helps drive those treatment decisions. […] There is a dose-response relationship between higher compliance with the ABCEDF bundle and higher survival, shorter time on mechanical ventilation, earlier discharge from the ICU and hospital, fewer bounce backs to the ICU, less delirium and coma, less use of restraints. […] The elements in the bundle help navigate towards less suffering for both patients and families and optimizing meaningful time with the people most important to our patients.

• #63 Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1374-x

  Delirium is a frequent complication of hospital admission among older people. Multicomponent interventions which can reduce incident delirium by one-third are recommended by the National Institute of Health and Care Excellence. Currently, a standardised delirium prevention system of care suitable for adoption in the UK National Health Service does not exist. The Prevention of Delirium (POD) system of care is a theory informed, multicomponent intervention and systematic implementation process which includes a role for hospital volunteers. […] Multicomponent delirium prevention interventions have been shown to reduce incident delirium in hospitalised patients by one-third. The National Institute of Health and Care Excellence (NICE) recommend implementation of these interventions in the National Health Service (NHS) in England and Wales.

• #64 Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1374-x

  The prevention of delirium system of care (POD) targets people at risk of delirium (65years; pre-existing cognitive impairment; current fractured hip; severe illness). It comprises actions summarised in protocols addressing ten modifiable risk factors associated with the development of delirium among vulnerable patients. Action is directed at changing ward practice with patients to optimise hydration and nutrition, reduce environmental threats, increase orientation to time and place, improve communication, support and encourage mobility, and effect better pain, infection and medication management. […] Training staff on delirium and preventive practices to facilitate their purposeful engagement in POD, making it meaningful and worthwhile to invest in; […] Establishing systems, processes and associated documentation to make POD workable and integrated into ward routines to facilitate enactment of POD practices by staff and volunteers individually and collectively;

• #65 Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1374-x

  The prevention of delirium system of care (POD) targets people at risk of delirium (65years; pre-existing cognitive impairment; current fractured hip; severe illness). It comprises actions summarised in protocols addressing ten modifiable risk factors associated with the development of delirium among vulnerable patients. Action is directed at changing ward practice with patients to optimise hydration and nutrition, reduce environmental threats, increase orientation to time and place, improve communication, support and encourage mobility, and effect better pain, infection and medication management. […] Training staff on delirium and preventive practices to facilitate their purposeful engagement in POD, making it meaningful and worthwhile to invest in; […] Establishing systems, processes and associated documentation to make POD workable and integrated into ward routines to facilitate enactment of POD practices by staff and volunteers individually and collectively;

• #66 Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1374-x

  The prevention of delirium system of care (POD) targets people at risk of delirium (65years; pre-existing cognitive impairment; current fractured hip; severe illness). It comprises actions summarised in protocols addressing ten modifiable risk factors associated with the development of delirium among vulnerable patients. Action is directed at changing ward practice with patients to optimise hydration and nutrition, reduce environmental threats, increase orientation to time and place, improve communication, support and encourage mobility, and effect better pain, infection and medication management. […] Training staff on delirium and preventive practices to facilitate their purposeful engagement in POD, making it meaningful and worthwhile to invest in; […] Establishing systems, processes and associated documentation to make POD workable and integrated into ward routines to facilitate enactment of POD practices by staff and volunteers individually and collectively;

• #67 Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00451

  The Society of Critical Care Medicine recently issued the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). […] Recommendations for delirium treatment strategies suggest that the application of dexmedetomidine may be a better treatment strategy than one that is based on benzodiazepine administration. […] Delirium is a disturbance of consciousness and cognition that occurs during a short period of time. It is associated with significantly increased morbidity and mortality rates in critically ill patients. […] Minimizing sedation using tactics such as daily interruptions of sedation can help to reduce exposure to delirogenic psychoactive medications. […] The application of benzodiazepines should be avoided in the ICU, except for the treatment of specific conditions.

• #68 Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00451

  The Society of Critical Care Medicine recently issued the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). […] Recommendations for delirium treatment strategies suggest that the application of dexmedetomidine may be a better treatment strategy than one that is based on benzodiazepine administration. […] Delirium is a disturbance of consciousness and cognition that occurs during a short period of time. It is associated with significantly increased morbidity and mortality rates in critically ill patients. […] Minimizing sedation using tactics such as daily interruptions of sedation can help to reduce exposure to delirogenic psychoactive medications. […] The application of benzodiazepines should be avoided in the ICU, except for the treatment of specific conditions.

• #69 Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00451

  The Society of Critical Care Medicine recently issued the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). […] Recommendations for delirium treatment strategies suggest that the application of dexmedetomidine may be a better treatment strategy than one that is based on benzodiazepine administration. […] Delirium is a disturbance of consciousness and cognition that occurs during a short period of time. It is associated with significantly increased morbidity and mortality rates in critically ill patients. […] Minimizing sedation using tactics such as daily interruptions of sedation can help to reduce exposure to delirogenic psychoactive medications. […] The application of benzodiazepines should be avoided in the ICU, except for the treatment of specific conditions.

• #70 Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00451

  The Society of Critical Care Medicine recently issued the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). […] Recommendations for delirium treatment strategies suggest that the application of dexmedetomidine may be a better treatment strategy than one that is based on benzodiazepine administration. […] Delirium is a disturbance of consciousness and cognition that occurs during a short period of time. It is associated with significantly increased morbidity and mortality rates in critically ill patients. […] Minimizing sedation using tactics such as daily interruptions of sedation can help to reduce exposure to delirogenic psychoactive medications. […] The application of benzodiazepines should be avoided in the ICU, except for the treatment of specific conditions.

• #71 Interventions to prevent delirium | Australian Commission on Safety and Quality in Health Care

  https://www.safetyandquality.gov.au/our-work/clinical-care-standards/delirium-clinical-care-standard/quality-statements/interventions-prevent-delirium

  A patient at risk of delirium is offered a set of interventions to prevent delirium and is regularly monitored for changes in behaviour, cognition and physical condition. Appropriate interventions are determined before a planned admission or on admission to hospital, in discussion with the patient and their family or carer. […] To reduce the incidence of delirium among patients who are at risk, and to prevent complications of delirium, such as falls, and improve outcomes. The regular monitoring of patients at risk of delirium can help to detect delirium promptly. […] Develop a delirium prevention plan, in partnership with the patient and family or carer, as part of a comprehensive care plan for those at risk of developing delirium. Offer at-risk patients appropriate multicomponent interventions to prevent delirium, while considering clinical risk factors and the setting. Discuss the interventions being put in place and encourage family or carers to be involved (for example, to orient and reassure the patient).

• #72 Interventions to prevent delirium | Australian Commission on Safety and Quality in Health Care

  https://www.safetyandquality.gov.au/our-work/clinical-care-standards/delirium-clinical-care-standard/quality-statements/interventions-prevent-delirium

  A patient at risk of delirium is offered a set of interventions to prevent delirium and is regularly monitored for changes in behaviour, cognition and physical condition. Appropriate interventions are determined before a planned admission or on admission to hospital, in discussion with the patient and their family or carer. […] To reduce the incidence of delirium among patients who are at risk, and to prevent complications of delirium, such as falls, and improve outcomes. The regular monitoring of patients at risk of delirium can help to detect delirium promptly. […] Develop a delirium prevention plan, in partnership with the patient and family or carer, as part of a comprehensive care plan for those at risk of developing delirium. Offer at-risk patients appropriate multicomponent interventions to prevent delirium, while considering clinical risk factors and the setting. Discuss the interventions being put in place and encourage family or carers to be involved (for example, to orient and reassure the patient).

• #73 Why We Must Prevent and Appropriately Manage Delirium | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/why-we-must-prevent-and-appropriately-manage-delirium/2023-10

  Despite the evidence pointing to the high prevalence of delirium, its associated morbidity, and opportunities to intervene, many institutions lack rigorous delirium prevention and mitigation strategies. […] There are policies we can and should implement to mitigate delirium’s prevalence and resulting mortality in hospitalized older adults. Hospital administration must emphasize programs such as the ABCDEF bundle and HELP. But policies are not enough; we must stay true to their intent by practicing in accordance with these policies, as we have an ethical responsibility to our patients to avoid the largely iatrogenic harms of delirium and to treat delirium as a pressing issue deserving of our attention and action.

• #74 CJCCN | A rapid scoping review of barriers and facilitators of implementing delirium prevention practices in adult critical care

  https://cjccn.ca/featured-article/a-rapid-scoping-review-of-barriers-and-facilitators-of-implementing-delirium-prevention-practices-in-adult-critical-care/

  Delirium prevention and management practices that have been proven effective include assessing, preventing, and adequately treating pain, use of spontaneous breathing trials to evaluate the need for mechanical ventilation, appropriate choice of analgesic and sedative agents, delirium screening, early mobilization, and family engagement. […] Implementing the ABCDEF bundle has shown meaningful improvements in patient outcomes related to delirium. […] Despite evidence that delirium prevention and management strategies are effective, such as the ABCDEF bundle, maintenance of a day-night routine, and sensory and orientation support, their implementation remains low. […] Implementation of delirium prevention and management practices depends on nurses prioritizing and integrating these strategies within the context of multiple competing care demands and established critical care practices and routines.

• #75 Instituting a Comprehensive Delirium Prevention Program at UCSF Medical Center

  https://www.asahq.org/brainhealthinitiative/publications-news-videos/articlesandnews/ucsfprogram

  Im confident that by being more aware of delirium as a serious issue for patients and aligning practice with best practice care recommendations that our patients and their families will benefit from improving the quality of care were providing. […] Delirium is a longitudinal problem. While we can try to align our care with best practices, we need to continue delirium prevention interventions after the patient leaves the OR and PACU. […] To get hospital leadership on board for a delirium prevention program, make a case for improving patient outcomes and potential cost savings. […] Implementing delirium best practices requires behavior change on the part of perioperative and other providers. […] Its important to understand your local culture and what is preventing change from happening to design an intervention that will address those issues, Donovan says.

• #76 Instituting a Comprehensive Delirium Prevention Program at UCSF Medical Center

  https://www.asahq.org/brainhealthinitiative/publications-news-videos/articlesandnews/ucsfprogram

  Im confident that by being more aware of delirium as a serious issue for patients and aligning practice with best practice care recommendations that our patients and their families will benefit from improving the quality of care were providing. […] Delirium is a longitudinal problem. While we can try to align our care with best practices, we need to continue delirium prevention interventions after the patient leaves the OR and PACU. […] To get hospital leadership on board for a delirium prevention program, make a case for improving patient outcomes and potential cost savings. […] Implementing delirium best practices requires behavior change on the part of perioperative and other providers. […] Its important to understand your local culture and what is preventing change from happening to design an intervention that will address those issues, Donovan says.

• #77 Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study | BMC Nursing | Full Text

  https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-022-01019-5

  Our study aimed to explore nurses perceptions of current non-pharmacological practices for delirium prevention, including delirium screening, early mobilisation, sleep promotion, family participation, and sensory stimulation in adult ICUs. […] The implementation of non-pharmacological delirium prevention practices was limited by a strict ICU visitation policy, lack of routine delirium screening and delirium training, safety concerns during implementation, light and noise disturbances during nighttime hours, and frequent resuscitation and new admissions. […] Case-based training, adopting a sensory stimulation protocol, and family engagement may be enablers. […] Family engagement is very important for the implementation of non-pharmacological delirium prevention practices. […] Providing more delirium knowledge to family caregivers is therefore vital in enhancing their understanding of nursing care and improving family-caregiver participation.

• #78

  https://link.springer.com/article/10.1007/s11606-023-08238-9

  The developed delirium program intends to achieve three goals: (a) to prevent the onset of delirium, (b) to identify delirium when present, and (c) to improve the evidence-based management of delirium when identified. […] The implementation of delirium prevention programs within hospitals is currently at the discretion of hospital leadership and as a result not universally applied. Therefore, the creation of a standard delirium strategy within all acute care centers that focuses on components such as prevention, screening, and delirium management strategies that are evidence based is needed. […] Our results demonstrate that the implementation of a multicomponent delirium program on general medicine hospital units is associated with reductions in delirium and falls, with the strongest effects seen in the most vulnerable patients. Hence, we believe that multi-component interventions focused on education and screening, with delirium prevention and management strategies, can have demonstrable impacts on changing patient outcomes, reduce harm, and improve practice.

• #79

  https://link.springer.com/article/10.1007/s11606-023-08238-9

  The developed delirium program intends to achieve three goals: (a) to prevent the onset of delirium, (b) to identify delirium when present, and (c) to improve the evidence-based management of delirium when identified. […] The implementation of delirium prevention programs within hospitals is currently at the discretion of hospital leadership and as a result not universally applied. Therefore, the creation of a standard delirium strategy within all acute care centers that focuses on components such as prevention, screening, and delirium management strategies that are evidence based is needed. […] Our results demonstrate that the implementation of a multicomponent delirium program on general medicine hospital units is associated with reductions in delirium and falls, with the strongest effects seen in the most vulnerable patients. Hence, we believe that multi-component interventions focused on education and screening, with delirium prevention and management strategies, can have demonstrable impacts on changing patient outcomes, reduce harm, and improve practice.

• #80

  https://link.springer.com/article/10.1007/s11606-023-08238-9

  The developed delirium program intends to achieve three goals: (a) to prevent the onset of delirium, (b) to identify delirium when present, and (c) to improve the evidence-based management of delirium when identified. […] The implementation of delirium prevention programs within hospitals is currently at the discretion of hospital leadership and as a result not universally applied. Therefore, the creation of a standard delirium strategy within all acute care centers that focuses on components such as prevention, screening, and delirium management strategies that are evidence based is needed. […] Our results demonstrate that the implementation of a multicomponent delirium program on general medicine hospital units is associated with reductions in delirium and falls, with the strongest effects seen in the most vulnerable patients. Hence, we believe that multi-component interventions focused on education and screening, with delirium prevention and management strategies, can have demonstrable impacts on changing patient outcomes, reduce harm, and improve practice.

• #81

  https://link.springer.com/article/10.1007/s11606-023-08238-9

  The developed delirium program intends to achieve three goals: (a) to prevent the onset of delirium, (b) to identify delirium when present, and (c) to improve the evidence-based management of delirium when identified. […] The implementation of delirium prevention programs within hospitals is currently at the discretion of hospital leadership and as a result not universally applied. Therefore, the creation of a standard delirium strategy within all acute care centers that focuses on components such as prevention, screening, and delirium management strategies that are evidence based is needed. […] Our results demonstrate that the implementation of a multicomponent delirium program on general medicine hospital units is associated with reductions in delirium and falls, with the strongest effects seen in the most vulnerable patients. Hence, we believe that multi-component interventions focused on education and screening, with delirium prevention and management strategies, can have demonstrable impacts on changing patient outcomes, reduce harm, and improve practice.

• #82 Instituting a Comprehensive Delirium Prevention Program at UCSF Medical Center

  https://www.asahq.org/brainhealthinitiative/publications-news-videos/articlesandnews/ucsfprogram

  Leveraging the EHR to automate delirium risk stratification where possible to warn providers and improve compliance was a really helpful key to ultimately changing practice, Donovan says. […] The project, run by UCSF Medical Centers anesthesia resident quality improvement committee, focused on reducing the use high risk medications and improving non-pharmacologic delirium prevention compliance in the PACU. […] Now embedded into the EHR is a specific PACU order set for patients who were at high risk of delirium, including removing three specific high-risk medications from the PACU order set: meperidine, metoclopramide, and prochlorperazine. […] Education was also provided to surgical services more by the hospital wide committee. […] We also measured a number of process metrics, including use of the appropriate PACU order set and compliance with the delirium screening preoperatively.

• #83 Instituting a Comprehensive Delirium Prevention Program at UCSF Medical Center

  https://www.asahq.org/brainhealthinitiative/publications-news-videos/articlesandnews/ucsfprogram

  Because nurses are instrumental in providing delirium screening, its important to recruit nursing champions who are interested in delirium and enthusiastic about making the case for why delirium assessment is important with their colleagues. […] We built the screening tool into the EHR and order sets, and automated EHR reminders to fill out the appropriate order set. […] We still have all the processes in place.

• #84 Instituting a Comprehensive Delirium Prevention Program at UCSF Medical Center

  https://www.asahq.org/brainhealthinitiative/publications-news-videos/articlesandnews/ucsfprogram

  Because nurses are instrumental in providing delirium screening, its important to recruit nursing champions who are interested in delirium and enthusiastic about making the case for why delirium assessment is important with their colleagues. […] We built the screening tool into the EHR and order sets, and automated EHR reminders to fill out the appropriate order set. […] We still have all the processes in place.

• #85

  https://link.springer.com/article/10.1007/s11606-023-08238-9

  The developed delirium program intends to achieve three goals: (a) to prevent the onset of delirium, (b) to identify delirium when present, and (c) to improve the evidence-based management of delirium when identified. […] The implementation of delirium prevention programs within hospitals is currently at the discretion of hospital leadership and as a result not universally applied. Therefore, the creation of a standard delirium strategy within all acute care centers that focuses on components such as prevention, screening, and delirium management strategies that are evidence based is needed. […] Our results demonstrate that the implementation of a multicomponent delirium program on general medicine hospital units is associated with reductions in delirium and falls, with the strongest effects seen in the most vulnerable patients. Hence, we believe that multi-component interventions focused on education and screening, with delirium prevention and management strategies, can have demonstrable impacts on changing patient outcomes, reduce harm, and improve practice.

• #86

  https://link.springer.com/article/10.1007/s11606-023-08238-9

  The developed delirium program intends to achieve three goals: (a) to prevent the onset of delirium, (b) to identify delirium when present, and (c) to improve the evidence-based management of delirium when identified. […] The implementation of delirium prevention programs within hospitals is currently at the discretion of hospital leadership and as a result not universally applied. Therefore, the creation of a standard delirium strategy within all acute care centers that focuses on components such as prevention, screening, and delirium management strategies that are evidence based is needed. […] Our results demonstrate that the implementation of a multicomponent delirium program on general medicine hospital units is associated with reductions in delirium and falls, with the strongest effects seen in the most vulnerable patients. Hence, we believe that multi-component interventions focused on education and screening, with delirium prevention and management strategies, can have demonstrable impacts on changing patient outcomes, reduce harm, and improve practice.

• #87 Delirium Prevention and Treatment: How to Improve Care and Avoid Unnecessary Costs | Institute for Healthcare Improvement

  https://www.ihi.org/insights/delirium-prevention-and-treatment-how-improve-care-and-avoid-unnecessary-costs

  Preventing delirium can spare patients from a potentially horrible experience while also avoiding unnecessary costs. […] The business case for preventing delirium is based on lowering the hospital length of stay (LOS) and the daily cost. […] ADAPT’s delirium care pathway is straightforward: screen all patients for delirium, prevent cases from developing, treat those that do, and manage cases that cannot be resolved. […] While the absence of data from a randomized control group makes it challenging to rigorously establish the ROI from ADAPT, the heavy financial burden that delirium imposes on this hospital, together with the low costs of ADAPT, sets up a plausibly strong business case for the efforts to prevent it. […] Delirium cases are enormously expensive at Hartford Hospital. […] The payer mix and payment systems under which Hartford Hospital operates ensure that the financial savings from ADAPT’s prevention efforts accrue to the larger Hartford HealthCare system.

• #88 Delirium Prevention and Treatment: How to Improve Care and Avoid Unnecessary Costs | Institute for Healthcare Improvement

  https://www.ihi.org/insights/delirium-prevention-and-treatment-how-improve-care-and-avoid-unnecessary-costs

  Preventing delirium can spare patients from a potentially horrible experience while also avoiding unnecessary costs. […] The business case for preventing delirium is based on lowering the hospital length of stay (LOS) and the daily cost. […] ADAPT’s delirium care pathway is straightforward: screen all patients for delirium, prevent cases from developing, treat those that do, and manage cases that cannot be resolved. […] While the absence of data from a randomized control group makes it challenging to rigorously establish the ROI from ADAPT, the heavy financial burden that delirium imposes on this hospital, together with the low costs of ADAPT, sets up a plausibly strong business case for the efforts to prevent it. […] Delirium cases are enormously expensive at Hartford Hospital. […] The payer mix and payment systems under which Hartford Hospital operates ensure that the financial savings from ADAPT’s prevention efforts accrue to the larger Hartford HealthCare system.

• #89 Delirium Prevention and Treatment: How to Improve Care and Avoid Unnecessary Costs | Institute for Healthcare Improvement

  https://www.ihi.org/insights/delirium-prevention-and-treatment-how-improve-care-and-avoid-unnecessary-costs

  Preventing delirium can spare patients from a potentially horrible experience while also avoiding unnecessary costs. […] The business case for preventing delirium is based on lowering the hospital length of stay (LOS) and the daily cost. […] ADAPT’s delirium care pathway is straightforward: screen all patients for delirium, prevent cases from developing, treat those that do, and manage cases that cannot be resolved. […] While the absence of data from a randomized control group makes it challenging to rigorously establish the ROI from ADAPT, the heavy financial burden that delirium imposes on this hospital, together with the low costs of ADAPT, sets up a plausibly strong business case for the efforts to prevent it. […] Delirium cases are enormously expensive at Hartford Hospital. […] The payer mix and payment systems under which Hartford Hospital operates ensure that the financial savings from ADAPT’s prevention efforts accrue to the larger Hartford HealthCare system.

• #90 Delirium Prevention and Treatment: How to Improve Care and Avoid Unnecessary Costs | Institute for Healthcare Improvement

  https://www.ihi.org/insights/delirium-prevention-and-treatment-how-improve-care-and-avoid-unnecessary-costs

  While no concrete data have yet been reported on ADAPT’s effectiveness, it is highly likely that it is cost-beneficial. […] ADAPT, HELP, and other similar age-friendly initiatives to address delirium while also averting other iatrogenic events, such as falls, infections, and pressure sores, make a plausibly strong business case for their adoption.

• #91 Delirium Prevention and Treatment: How to Improve Care and Avoid Unnecessary Costs | Institute for Healthcare Improvement

  https://www.ihi.org/insights/delirium-prevention-and-treatment-how-improve-care-and-avoid-unnecessary-costs

  While no concrete data have yet been reported on ADAPT’s effectiveness, it is highly likely that it is cost-beneficial. […] ADAPT, HELP, and other similar age-friendly initiatives to address delirium while also averting other iatrogenic events, such as falls, infections, and pressure sores, make a plausibly strong business case for their adoption.

• #92 Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00451

  Delirium is an acute, confusional state characterized by altered consciousness and a reduced ability to focus, sustain, or shift attention. […] Therefore, the early recognition of delirium is important and ICU medical staff should devote careful attention to both watching for the occurrence of delirium and its prevention and management. […] Critically ill adults should be regularly assessed for delirium using a valid tool and predictive models that include delirium risk factors at the time of ICU admission and during the first 24 hours thereafter. […] Most ICUs employ nonpharmacologic methods to reduce or prevent delirium. Regularly allaying anxiety and orienting patients, reducing environmental noise and the use of alarms, establishing light use consistent with daynight circadian cycles, and encouraging early mobility are some examples of strategies.

• #93 Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00451

  Delirium is an acute, confusional state characterized by altered consciousness and a reduced ability to focus, sustain, or shift attention. […] Therefore, the early recognition of delirium is important and ICU medical staff should devote careful attention to both watching for the occurrence of delirium and its prevention and management. […] Critically ill adults should be regularly assessed for delirium using a valid tool and predictive models that include delirium risk factors at the time of ICU admission and during the first 24 hours thereafter. […] Most ICUs employ nonpharmacologic methods to reduce or prevent delirium. Regularly allaying anxiety and orienting patients, reducing environmental noise and the use of alarms, establishing light use consistent with daynight circadian cycles, and encouraging early mobility are some examples of strategies.

• #94 Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00451

  Delirium is an acute, confusional state characterized by altered consciousness and a reduced ability to focus, sustain, or shift attention. […] Therefore, the early recognition of delirium is important and ICU medical staff should devote careful attention to both watching for the occurrence of delirium and its prevention and management. […] Critically ill adults should be regularly assessed for delirium using a valid tool and predictive models that include delirium risk factors at the time of ICU admission and during the first 24 hours thereafter. […] Most ICUs employ nonpharmacologic methods to reduce or prevent delirium. Regularly allaying anxiety and orienting patients, reducing environmental noise and the use of alarms, establishing light use consistent with daynight circadian cycles, and encouraging early mobility are some examples of strategies.

• #95 CJCCN | A rapid scoping review of barriers and facilitators of implementing delirium prevention practices in adult critical care

  https://cjccn.ca/featured-article/a-rapid-scoping-review-of-barriers-and-facilitators-of-implementing-delirium-prevention-practices-in-adult-critical-care/

  Delirium prevention and management practices that have been proven effective include assessing, preventing, and adequately treating pain, use of spontaneous breathing trials to evaluate the need for mechanical ventilation, appropriate choice of analgesic and sedative agents, delirium screening, early mobilization, and family engagement. […] Implementing the ABCDEF bundle has shown meaningful improvements in patient outcomes related to delirium. […] Despite evidence that delirium prevention and management strategies are effective, such as the ABCDEF bundle, maintenance of a day-night routine, and sensory and orientation support, their implementation remains low. […] Implementation of delirium prevention and management practices depends on nurses prioritizing and integrating these strategies within the context of multiple competing care demands and established critical care practices and routines.

• #96 Many older adults miss out on delirium prevention measures before surgery: study – McKnight’s Long-Term Care News

  https://www.mcknights.com/news/many-older-adults-miss-out-on-delirium-prevention-measures-before-surgery-study/

  Not knowing an older adults cognitive status before surgery can mean that doctors dont know if a patient is at risk for delirium after surgery. As a result, that patient may miss out on much-needed interventions, a new study finds. […] Postoperative delirium is a common complication in older adults who have surgery. Already having cognitive impairment or dementia is a risk factor for postoperative delirium, and interventions can prevent it in those at risk. The researchers looked at how often preventive interventions for delirium arent included in those at risk. Authors of the report said at least one of the three known preventative measures wasnt applied to about 70% of people who underwent spine surgery. […] The prevention methods include delirium prevention orders, sleep orders and avoiding potentially inappropriate medications (PIMs) listed in the AGS Beers Criteria.

• #97 Many older adults miss out on delirium prevention measures before surgery: study – McKnight’s Long-Term Care News

  https://www.mcknights.com/news/many-older-adults-miss-out-on-delirium-prevention-measures-before-surgery-study/

  Not knowing an older adults cognitive status before surgery can mean that doctors dont know if a patient is at risk for delirium after surgery. As a result, that patient may miss out on much-needed interventions, a new study finds. […] Postoperative delirium is a common complication in older adults who have surgery. Already having cognitive impairment or dementia is a risk factor for postoperative delirium, and interventions can prevent it in those at risk. The researchers looked at how often preventive interventions for delirium arent included in those at risk. Authors of the report said at least one of the three known preventative measures wasnt applied to about 70% of people who underwent spine surgery. […] The prevention methods include delirium prevention orders, sleep orders and avoiding potentially inappropriate medications (PIMs) listed in the AGS Beers Criteria.

• #98 Many older adults miss out on delirium prevention measures before surgery: study – McKnight’s Long-Term Care News

  https://www.mcknights.com/news/many-older-adults-miss-out-on-delirium-prevention-measures-before-surgery-study/

  Not knowing an older adults cognitive status before surgery can mean that doctors dont know if a patient is at risk for delirium after surgery. As a result, that patient may miss out on much-needed interventions, a new study finds. […] Postoperative delirium is a common complication in older adults who have surgery. Already having cognitive impairment or dementia is a risk factor for postoperative delirium, and interventions can prevent it in those at risk. The researchers looked at how often preventive interventions for delirium arent included in those at risk. Authors of the report said at least one of the three known preventative measures wasnt applied to about 70% of people who underwent spine surgery. […] The prevention methods include delirium prevention orders, sleep orders and avoiding potentially inappropriate medications (PIMs) listed in the AGS Beers Criteria.

• #99 Many older adults miss out on delirium prevention measures before surgery: study – McKnight’s Long-Term Care News

  https://www.mcknights.com/news/many-older-adults-miss-out-on-delirium-prevention-measures-before-surgery-study/

  Not knowing an older adults cognitive status before surgery can mean that doctors dont know if a patient is at risk for delirium after surgery. As a result, that patient may miss out on much-needed interventions, a new study finds. […] Postoperative delirium is a common complication in older adults who have surgery. Already having cognitive impairment or dementia is a risk factor for postoperative delirium, and interventions can prevent it in those at risk. The researchers looked at how often preventive interventions for delirium arent included in those at risk. Authors of the report said at least one of the three known preventative measures wasnt applied to about 70% of people who underwent spine surgery. […] The prevention methods include delirium prevention orders, sleep orders and avoiding potentially inappropriate medications (PIMs) listed in the AGS Beers Criteria.

• #100 Interventions to prevent delirium in hospitalised patients, not including those on intensive care units | Cochrane

  https://www.cochrane.org/CD005563/DEMENTIA_interventions-prevent-delirium-hospitalised-patients-not-including-those-intensive-care-units

  There is moderate-quality evidence to indicate that multi-component interventions reduce the incidence of delirium. The evidence supports implementing multi-component delirium prevention interventions into routine care for patients in hospital. […] There is moderate-quality evidence that monitoring depth of general anaesthesia can be used to prevent delirium postoperatively. […] There is strong evidence supporting multi-component interventions to prevent delirium in hospitalised patients. […] The role of drugs and other anaesthetic techniques to prevent delirium remains uncertain. […] We found multi-component interventions reduced the incidence of delirium compared to usual care (RR 0.69, 95% CI 0.59 to 0.81; seven studies; 1950 participants; moderate-quality evidence). […] There is moderate-quality evidence that Bispectral Index (BIS)-guided anaesthesia reduces the incidence of delirium compared to BIS-blinded anaesthesia or clinical judgement (RR 0.71, 95% CI 0.60 to 0.85; two studies; 2057 participants).

• #101 Interventions to prevent delirium in hospitalised patients, not including those on intensive care units | Cochrane

  https://www.cochrane.org/CD005563/DEMENTIA_interventions-prevent-delirium-hospitalised-patients-not-including-those-intensive-care-units

  There is moderate-quality evidence to indicate that multi-component interventions reduce the incidence of delirium. The evidence supports implementing multi-component delirium prevention interventions into routine care for patients in hospital. […] There is moderate-quality evidence that monitoring depth of general anaesthesia can be used to prevent delirium postoperatively. […] There is strong evidence supporting multi-component interventions to prevent delirium in hospitalised patients. […] The role of drugs and other anaesthetic techniques to prevent delirium remains uncertain. […] We found multi-component interventions reduced the incidence of delirium compared to usual care (RR 0.69, 95% CI 0.59 to 0.81; seven studies; 1950 participants; moderate-quality evidence). […] There is moderate-quality evidence that Bispectral Index (BIS)-guided anaesthesia reduces the incidence of delirium compared to BIS-blinded anaesthesia or clinical judgement (RR 0.71, 95% CI 0.60 to 0.85; two studies; 2057 participants).

• #102 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  In people in hospital who are at high risk of delirium, which medication (atypical antipsychotics, typical antipsychotics, benzodiazepines or acetylcholinesterase inhibitors), compared with placebo or each other, is more clinically and cost effective in preventing the development of delirium? […] Although there is moderate-quality evidence of clinical and cost effectiveness for multicomponent interventions for the prevention of delirium in people in hospital, there is no evidence in a long-term care setting. It is anticipated that such an intervention would benefit this long-term care population. […] This clinical guideline describes methods of preventing, identifying, diagnosing and treating delirium. In particular, the guideline focuses on preventing delirium in people identified to be at risk, using a targeted, multicomponent, non-pharmacological intervention that addresses a number of modifiable risk factors (clinical factors).

• #103 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  In people in hospital who are at high risk of delirium, which medication (atypical antipsychotics, typical antipsychotics, benzodiazepines or acetylcholinesterase inhibitors), compared with placebo or each other, is more clinically and cost effective in preventing the development of delirium? […] Although there is moderate-quality evidence of clinical and cost effectiveness for multicomponent interventions for the prevention of delirium in people in hospital, there is no evidence in a long-term care setting. It is anticipated that such an intervention would benefit this long-term care population. […] This clinical guideline describes methods of preventing, identifying, diagnosing and treating delirium. In particular, the guideline focuses on preventing delirium in people identified to be at risk, using a targeted, multicomponent, non-pharmacological intervention that addresses a number of modifiable risk factors (clinical factors).

• #104 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications. […] Be aware that people in hospital or long-term care may be at risk of delirium. This can have serious consequences (such as increased risk of dementia and/or death) and, for people in hospital, may increase their length of stay in hospital and their risk of new admission to long-term care. […] Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary.

• #105 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications. […] Be aware that people in hospital or long-term care may be at risk of delirium. This can have serious consequences (such as increased risk of dementia and/or death) and, for people in hospital, may increase their length of stay in hospital and their risk of new admission to long-term care. […] Ensure that people at risk of delirium are cared for by a team of healthcare professionals who are familiar to the person at risk. Avoid moving people within and between wards or rooms unless absolutely necessary.

• #106 Exploring Cognitive Stimulation as a Therapy for the Prevention of Delirium in a Hospital Setting: A Narrative Review

  https://www.mdpi.com/2076-328X/15/2/186

  Delirium is a highly prevalent and costly neuropsychiatric condition that affects up to 87% of critically ill hospitalized patients. Non-pharmacological interventions have been shown to reduce the incidence and duration of delirium, with strategies like reality orientation, cognitive stimulation, family support, and physical support. Cognitive stimulation (CS) engages patients in activities such as reality orientation, word searches, and board games to enhance cognitive functions, including attention, memory, and executive functions. CS is increasingly recognized as a potential preventive intervention for delirium, primarily due to its ability to enhance cognitive reserve, promote neuroplasticity, improve sensory engagement, and facilitate social interaction. However, implementing CS in acute hospital settings is challenged by factors such as limited resources, staffing shortages, and inadequate training among nursing staff. Recent studies suggest that incorporating games into CS and utilizing virtual reality (VR) for game-based CS can improve cognitive function and increase participant engagement. Thus, VR delivery of cognitive stimulation games is emerging as a potential solution to enhance patient engagement and overcome the scalability issues of current delirium prevention approaches. Delirium is preventable in up to 50% of patients, with the best preventive strategy being non-pharmacological interventions such as cognitive and sensory stimulation.

• #107 Exploring Cognitive Stimulation as a Therapy for the Prevention of Delirium in a Hospital Setting: A Narrative Review

  https://www.mdpi.com/2076-328X/15/2/186

  Delirium is a highly prevalent and costly neuropsychiatric condition that affects up to 87% of critically ill hospitalized patients. Non-pharmacological interventions have been shown to reduce the incidence and duration of delirium, with strategies like reality orientation, cognitive stimulation, family support, and physical support. Cognitive stimulation (CS) engages patients in activities such as reality orientation, word searches, and board games to enhance cognitive functions, including attention, memory, and executive functions. CS is increasingly recognized as a potential preventive intervention for delirium, primarily due to its ability to enhance cognitive reserve, promote neuroplasticity, improve sensory engagement, and facilitate social interaction. However, implementing CS in acute hospital settings is challenged by factors such as limited resources, staffing shortages, and inadequate training among nursing staff. Recent studies suggest that incorporating games into CS and utilizing virtual reality (VR) for game-based CS can improve cognitive function and increase participant engagement. Thus, VR delivery of cognitive stimulation games is emerging as a potential solution to enhance patient engagement and overcome the scalability issues of current delirium prevention approaches. Delirium is preventable in up to 50% of patients, with the best preventive strategy being non-pharmacological interventions such as cognitive and sensory stimulation.

• #108 Exploring Cognitive Stimulation as a Therapy for the Prevention of Delirium in a Hospital Setting: A Narrative Review

  https://www.mdpi.com/2076-328X/15/2/186

  Delirium is a highly prevalent and costly neuropsychiatric condition that affects up to 87% of critically ill hospitalized patients. Non-pharmacological interventions have been shown to reduce the incidence and duration of delirium, with strategies like reality orientation, cognitive stimulation, family support, and physical support. Cognitive stimulation (CS) engages patients in activities such as reality orientation, word searches, and board games to enhance cognitive functions, including attention, memory, and executive functions. CS is increasingly recognized as a potential preventive intervention for delirium, primarily due to its ability to enhance cognitive reserve, promote neuroplasticity, improve sensory engagement, and facilitate social interaction. However, implementing CS in acute hospital settings is challenged by factors such as limited resources, staffing shortages, and inadequate training among nursing staff. Recent studies suggest that incorporating games into CS and utilizing virtual reality (VR) for game-based CS can improve cognitive function and increase participant engagement. Thus, VR delivery of cognitive stimulation games is emerging as a potential solution to enhance patient engagement and overcome the scalability issues of current delirium prevention approaches. Delirium is preventable in up to 50% of patients, with the best preventive strategy being non-pharmacological interventions such as cognitive and sensory stimulation.

• #109 Exploring Cognitive Stimulation as a Therapy for the Prevention of Delirium in a Hospital Setting: A Narrative Review

  https://www.mdpi.com/2076-328X/15/2/186

  Delirium is a highly prevalent and costly neuropsychiatric condition that affects up to 87% of critically ill hospitalized patients. Non-pharmacological interventions have been shown to reduce the incidence and duration of delirium, with strategies like reality orientation, cognitive stimulation, family support, and physical support. Cognitive stimulation (CS) engages patients in activities such as reality orientation, word searches, and board games to enhance cognitive functions, including attention, memory, and executive functions. CS is increasingly recognized as a potential preventive intervention for delirium, primarily due to its ability to enhance cognitive reserve, promote neuroplasticity, improve sensory engagement, and facilitate social interaction. However, implementing CS in acute hospital settings is challenged by factors such as limited resources, staffing shortages, and inadequate training among nursing staff. Recent studies suggest that incorporating games into CS and utilizing virtual reality (VR) for game-based CS can improve cognitive function and increase participant engagement. Thus, VR delivery of cognitive stimulation games is emerging as a potential solution to enhance patient engagement and overcome the scalability issues of current delirium prevention approaches. Delirium is preventable in up to 50% of patients, with the best preventive strategy being non-pharmacological interventions such as cognitive and sensory stimulation.

• #110 Exploring Cognitive Stimulation as a Therapy for the Prevention of Delirium in a Hospital Setting: A Narrative Review

  https://www.mdpi.com/2076-328X/15/2/186

  Delirium is a highly prevalent and costly neuropsychiatric condition that affects up to 87% of critically ill hospitalized patients. Non-pharmacological interventions have been shown to reduce the incidence and duration of delirium, with strategies like reality orientation, cognitive stimulation, family support, and physical support. Cognitive stimulation (CS) engages patients in activities such as reality orientation, word searches, and board games to enhance cognitive functions, including attention, memory, and executive functions. CS is increasingly recognized as a potential preventive intervention for delirium, primarily due to its ability to enhance cognitive reserve, promote neuroplasticity, improve sensory engagement, and facilitate social interaction. However, implementing CS in acute hospital settings is challenged by factors such as limited resources, staffing shortages, and inadequate training among nursing staff. Recent studies suggest that incorporating games into CS and utilizing virtual reality (VR) for game-based CS can improve cognitive function and increase participant engagement. Thus, VR delivery of cognitive stimulation games is emerging as a potential solution to enhance patient engagement and overcome the scalability issues of current delirium prevention approaches. Delirium is preventable in up to 50% of patients, with the best preventive strategy being non-pharmacological interventions such as cognitive and sensory stimulation.

• #111 ADAPT » PRISMAp » College of Medicine » University of Florida

  https://prismap.medicine.ufl.edu/research/adapt/

  Delirium is a common acute brain dysfunction syndrome affecting up to 50% of patients in the intensive care unit (ICU). […] Non-pharmacological approaches remain the cornerstone of delirium prevention, but the strategy of observing patient mobility and circadian desynchrony due to sleep disruption and light and noise exposure often falls short due to sporadic human observations. […] Our central hypothesis is that ADAPT will be superior to existing approaches for identifying high-risk patients by autonomously monitoring uncaptured delirium risk factors, and will ultimately provide an effective, non-pharmacological adaptive prevention strategy for delirium in the ICU. […] This tool will be developed and validated in terms of a) predictions of delirium trajectory transitions that are precise and interpretable, b) autonomous monitoring and quantification of mobility and circadian cues that correlate to mobility assessments and circadian biomarkers, and c) adaptive prevention with real-time action prompts that ICU physicians are satisfied with. […] ADAPTs successful application would augment clinical decision-making by streamlining clinical processes and overall improve patient outcomes in the ICU.

• #112 ADAPT » PRISMAp » College of Medicine » University of Florida

  https://prismap.medicine.ufl.edu/research/adapt/

  Delirium is a common acute brain dysfunction syndrome affecting up to 50% of patients in the intensive care unit (ICU). […] Non-pharmacological approaches remain the cornerstone of delirium prevention, but the strategy of observing patient mobility and circadian desynchrony due to sleep disruption and light and noise exposure often falls short due to sporadic human observations. […] Our central hypothesis is that ADAPT will be superior to existing approaches for identifying high-risk patients by autonomously monitoring uncaptured delirium risk factors, and will ultimately provide an effective, non-pharmacological adaptive prevention strategy for delirium in the ICU. […] This tool will be developed and validated in terms of a) predictions of delirium trajectory transitions that are precise and interpretable, b) autonomous monitoring and quantification of mobility and circadian cues that correlate to mobility assessments and circadian biomarkers, and c) adaptive prevention with real-time action prompts that ICU physicians are satisfied with. […] ADAPTs successful application would augment clinical decision-making by streamlining clinical processes and overall improve patient outcomes in the ICU.

• #113 ADAPT » PRISMAp » College of Medicine » University of Florida

  https://prismap.medicine.ufl.edu/research/adapt/

  Delirium is a common acute brain dysfunction syndrome affecting up to 50% of patients in the intensive care unit (ICU). […] Non-pharmacological approaches remain the cornerstone of delirium prevention, but the strategy of observing patient mobility and circadian desynchrony due to sleep disruption and light and noise exposure often falls short due to sporadic human observations. […] Our central hypothesis is that ADAPT will be superior to existing approaches for identifying high-risk patients by autonomously monitoring uncaptured delirium risk factors, and will ultimately provide an effective, non-pharmacological adaptive prevention strategy for delirium in the ICU. […] This tool will be developed and validated in terms of a) predictions of delirium trajectory transitions that are precise and interpretable, b) autonomous monitoring and quantification of mobility and circadian cues that correlate to mobility assessments and circadian biomarkers, and c) adaptive prevention with real-time action prompts that ICU physicians are satisfied with. […] ADAPTs successful application would augment clinical decision-making by streamlining clinical processes and overall improve patient outcomes in the ICU.

• #114 ADAPT » PRISMAp » College of Medicine » University of Florida

  https://prismap.medicine.ufl.edu/research/adapt/

  Delirium is a common acute brain dysfunction syndrome affecting up to 50% of patients in the intensive care unit (ICU). […] Non-pharmacological approaches remain the cornerstone of delirium prevention, but the strategy of observing patient mobility and circadian desynchrony due to sleep disruption and light and noise exposure often falls short due to sporadic human observations. […] Our central hypothesis is that ADAPT will be superior to existing approaches for identifying high-risk patients by autonomously monitoring uncaptured delirium risk factors, and will ultimately provide an effective, non-pharmacological adaptive prevention strategy for delirium in the ICU. […] This tool will be developed and validated in terms of a) predictions of delirium trajectory transitions that are precise and interpretable, b) autonomous monitoring and quantification of mobility and circadian cues that correlate to mobility assessments and circadian biomarkers, and c) adaptive prevention with real-time action prompts that ICU physicians are satisfied with. […] ADAPTs successful application would augment clinical decision-making by streamlining clinical processes and overall improve patient outcomes in the ICU.

• #115 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  Carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications. […] Address poor nutrition by: following the advice given on nutrition in the NICE guideline on nutrition support for adults; if people have dentures, ensuring they fit properly. […] Address sensory impairment by: resolving any reversible cause of the impairment, such as impacted ear wax; ensuring hearing and visual aids are available to and used by people who need them, and that they are in good working order. […] Promote good sleep patterns and sleep hygiene by: avoiding nursing or medical procedures during sleeping hours, if possible; scheduling medication rounds to avoid disturbing sleep; reducing noise to a minimum during sleep periods. […] The guideline committee has made the following key recommendations for research.

• #116 Delirium: prevention, diagnosis and management in hospital and long-term care – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK553009/

  In people in hospital who are at high risk of delirium, which medication (atypical antipsychotics, typical antipsychotics, benzodiazepines or acetylcholinesterase inhibitors), compared with placebo or each other, is more clinically and cost effective in preventing the development of delirium? […] Although there is moderate-quality evidence of clinical and cost effectiveness for multicomponent interventions for the prevention of delirium in people in hospital, there is no evidence in a long-term care setting. It is anticipated that such an intervention would benefit this long-term care population. […] This clinical guideline describes methods of preventing, identifying, diagnosing and treating delirium. In particular, the guideline focuses on preventing delirium in people identified to be at risk, using a targeted, multicomponent, non-pharmacological intervention that addresses a number of modifiable risk factors (clinical factors).

• #117

  https://juniperpublishers.com/oajnn/OAJNN.MS.ID.555984.php

  Delirium can be prevented by taking necessary precautions. Promising preventive measures, including cognitive stimulation, early mobilization, and medication review, have shown efficacy in reducing the incidence and severity of delirium. […] Understanding the epidemiology and risk factors of delirium enables the implementation of targeted preventive strategies tailored to address these factors. By identifying high-risk individuals, healthcare professionals can intervene early and mitigate the delirium burden. […] Promising preventive measures, including cognitive stimulation, early mobilization, and medication review, have shown efficacy in reducing the incidence and severity of delirium. However, further research is warranted to deepen our understanding of the intricate interplay of risk factors and to develop precise interventions for effectively preventing and managing delirium.

• #118

  https://juniperpublishers.com/oajnn/OAJNN.MS.ID.555984.php

  By addressing and modifying these preoperative risk factors through a comprehensive preoperative assessment, healthcare professionals can work towards minimizing the occurrence of delirium and improving patient outcomes. […] The treatment of delirium in hospitalized patients requires a multidimensional approach. Pharmacological interventions, non-pharmacological strategies, and addressing underlying causes all play a crucial role in managing delirium effectively. A comprehensive care plan that includes family involvement and education can further optimize patient outcomes. Future research should focus on evaluating the long-term effects of different treatment modalities and identifying personalized approaches for specific patient populations.

• #119 The inter-relationship between delirium and dementia: the importance of delirium prevention | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-022-00698-7

  Delirium prevention strategies can reduce the incidence of delirium and associated adverse outcomes, including falls and functional decline. […] Therefore, delirium might represent a modifiable risk factor for dementia, and interventions that prevent or minimize delirium might also reduce or prevent long-term cognitive impairment. […] Adverse outcomes associated with delirium, such as the onset of dementia symptoms in individuals with preclinical dementia, and/or the acceleration of cognitive decline in individuals with dementia might also be delayed by the implementation of delirium prevention strategies. […] Schnitker, L. et al. Prevention of delirium in older adults with dementia: a systematic literature review. […] Freter, S., Koller, K., Dunbar, M., MacKnight, C. Rockwood, K. Translating delirium prevention strategies for elderly adults with hip fracture into routine clinical care: a pragmatic clinical trial.

• #120 The inter-relationship between delirium and dementia: the importance of delirium prevention | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-022-00698-7

  Delirium prevention strategies can reduce the incidence of delirium and associated adverse outcomes, including falls and functional decline. […] Therefore, delirium might represent a modifiable risk factor for dementia, and interventions that prevent or minimize delirium might also reduce or prevent long-term cognitive impairment. […] Adverse outcomes associated with delirium, such as the onset of dementia symptoms in individuals with preclinical dementia, and/or the acceleration of cognitive decline in individuals with dementia might also be delayed by the implementation of delirium prevention strategies. […] Schnitker, L. et al. Prevention of delirium in older adults with dementia: a systematic literature review. […] Freter, S., Koller, K., Dunbar, M., MacKnight, C. Rockwood, K. Translating delirium prevention strategies for elderly adults with hip fracture into routine clinical care: a pragmatic clinical trial.

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