21 Identification and management of delirium in the palliative inpatient unit

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Abstract

Introduction

Delirium is an acute confusional state. The incidence of delirium in palliative care units is estimated between 13% and 42% (Hosie 2014). Delirium is associated with an increase in mortality and length of hospice stay yet it is poorly identified. Up to 50% of cases of delirium are reversible (Lawlor 2000) as such early identification and impeccable assessment and treatment could relieve the suffering.

Aim

To assess identification and management of delirium in two hospices.

Methods

Retrospective notes analysis to identify patients with delirium whether they were coded with a delirium diagnosis and whether the management of delirium followed best practice.

Results

77 inpatients across two hospices were assessed in one month in 2018. There were 37 episodes of possible delirium only five were coded as delirium none had assessment with a recognised delirium tool. Reversibility was considered for 48 episodes; it was not clear from the documentation that this was all possible reversible causes. Family were kept informed 94% of the time. A management plan was documented for five patients.

Conclusion

Delirium was being considered but not documented a common problem in medical notes. Documentation of a management plan was poor but when there was a plan best practice was followed with non-pharmacological management then low dose antipsychotic with stronger sedation reserved for terminal agitation. An education feedback loop formal training on delirium and design of an electronic medical record template to prompt the management of delirium is ongoing. Practice will be reassessed three months after this intervention.

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