AIGNA Care of Older Person Ireland

1. Delirium in Acute Care - Could we do better?
Aisling McCloskey
Trauma & Orthopaedic Fracture Outcomes Nurse
Florence Sharkey
Lead Nurse Research and Development

2. Project Aim:
 Improve delirium awareness, prevention and
management
 Educate staff, inform patients and families
about the risks
 Reduce incidence of delirium in the Trauma
and Orthopaedic Unit

3. Objectives
 Define delirium
 How it co exists with dementia
 Demonstrate quality improvement that is
Person-centred

4. Dementia Prevalence
 In Northern Ireland approximately 19,000 people
are living with dementia, a number projected to rise
to almost 60,000 by 2051 (DHSSPS 2010 & Age
NI, 2015)
 A quarter of all hospital beds in Northern Ireland
are occupied with dementia patients

5. What is Delirium?
Delirium is sometimes called ‘acute confusional state’
– Types of delirium
Hyper-active delirium, Hypoactive delirium & Mixed delirium
– 4 risk factors of delirium
Dementia
Over 65
Years Old
Acutely
Unwell
Fractured
Femur

6. Delirium
• It is common and is associated with poor health
outcomes with increases in:
• Length of stay in hospital
• In-hospital complications
• Risk of admission to long-term care
• Risk of dementia
• Risk of death
• Delirium can be preventable and treatable if dealt with
urgently.

7. The
Regional
Delirium
Clinical
Record
Tool

8. Results: Is the person more
confused than normal?

9. Results/Audit of 4AT scores

11. Delirium Triggers

14. 10,000 More Voices
Although Dad has Parkinson's he was very able &
sound of mind before the operation. Although we
were warned by staff and friend that delirium can
set in after surgery we were very shocked and
upset by how much it affected Dad. He was like a
different person and not himself at all which was
very frightening especially for my mother. Staff in
the hospital were very reassuring but days passed
into weeks and Dad still had delirium.

15. 10,000 More Voices
Never heard the
word before until my
relative came into
hospital, then staff
spoke about it but I'm
not much wiser
what it is.
He gets muddled up
when he is brewing
an infection. The staff
were very attentive and
Caring. I was allowed
to stay as long as
I wanted.

16. World Delirium Awareness Day

17. Conclusion
 Staff are more aware of
Delirium in providing Person-
centred care
 Delirium identified at an early
stage
 Underlying causes treated
promptly
 Less Pharmalogical
interventions used to treat
Delirium
 Delirium episodes being
recorded on discharge
letters
 Raising awareness in the
community settings & for
future admissions.
 Prevalence of Delirium
reducing in the ward
 Patients and their families
have much more positive
experiences in hospital

18.  Education and training needs to continue to extend
application of the tool to other clinical areas
 Support from management and clinical professionals
 Evidence of the impact of this innovation will be
assessed through audits & feedback
 The Lead Nurse for Research & Development will
provide updates & reports to the ward
managers/Assistant Director for Nursing
Discussion