Delirium is an acute disturbance in a person’s attention, awareness and cognition that can be caused by an acute medical condition or medication changes. Delirium is serious and may be the only sign of a deteriorating patient.

Delirium should be treated as a medical emergency.

Delirium is common in older patients, yet it is often overlooked, misdiagnosed and poorly managed. This can lead to the person experiencing falls, incontinence, malnutrition, dehydration, infections and pressure injuries.

Delirium can often be prevented and can be treated and managed. As clinicians we must listen to the families of our patients when they tell us the person seems confused. If the person does not have family or friends visiting regularly, we need to be extra vigilant to detect changes in a person’s behaviour and investigate promptly. All team members are responsible for this and should feel confident to escalate their concerns. 

This topic gives an overview of delirium, its risk factors, how to prevent it occurring and how to manage its symptoms once diagnosed.

In addition to following health service policy and procedures, consider the recommended actions and discuss them with colleagues and managers.

All Australian hospitals are being accredited under The Australian Commission on Safety and Quality in Healthcare’s (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards. Each of the ten standards relate to optimising clinical care and better outcomes for all patients. The Commission has identified that cognitive impairment is under-recognised in Australian Hospitals leading to significant safety and quality issues in the care of patients.

The NSQHS Standards can support a nationally coordinated improvement in the care of people with cognitive impairment in acute care. The Commission released A better way to care: safe and high quality care for patients with cognitive impairment (dementia and delirium) in hospital in 2014.

As a stand-alone clinical care standard, this will assist you and your organisation to meet the requirements of the NSQHS Standards recognising and responding to clinical deterioration (standard 9), preventing falls and harm from falls (standard 10) and medication safety (standard 4).

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