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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Initial management of the condition should address three simultaneous priorities:

  • maintenance of the patient’s safety
    • protect airway and prevent aspiration
    • maintenance of hydration and nutrition
    • prevention of skin breakdown
    • provision of safe mobility while preventing falls
    • restraints and bed alarms should be avoided since they increase the risk and persistence of the condition
  • identification of the cause or causes
    • in people diagnosed with delirium, identify and manage the possible underlying cause or combination of causes
  • non pharmacological prevention and treatment
    • once the causative factors are addressed, focus should shift to nonpharmacologic measures providing supportive care, and preventing complications
    • a 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
      • 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
        • taking advice if necessary when managing fluid balance in people with comorbidities (for example, heart failure or chronic kidney disease)
      • 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
      • 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)
        • encourage all people, including those unable to walk, to carry out active range-of-motion exercises
      • 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
      • carry out a medication review for people taking multiple drugs, taking into account both the type and number of medications
      • address poor nutrition
      • 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 (1,2)

Pharmacological treatment

  • if a person with delirium is distressed or considered a risk to themselves or others and verbal and non-verbal de-escalation techniques are ineffective or inappropriate, consider giving short-term (usually for 1 week or less) haloperidol. Start at the lowest clinically appropriate dose and titrate cautiously according to symptoms.
  • use antipsychotic drugs with caution or not at all for people with conditions such as Parkinson's disease or dementia with Lewy bodies (3)


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