Recognising early signs of delirium could help prevent the patient becoming more unwell and in some cases, could prevent their death.
Over the past 10 years or so dementia has, quite rightly, been the focus of a great many policies, commissioning guidelines, calls to action and educational initiatives. As a result, great strides have been made in improving the experience of people living with dementia and their families. Of course, there is always a need to continue improving and perhaps the next step in this improvement journey is to focus on delirium.
Some acute hospitals have already made the connection between dementia and delirium, understanding how undiagnosed delirium can create the negative experiences so often reported by people with dementia and their families, and are turning their attention to its early recognition, prevention and management.
However, if we are to see a reduction in the severity of the delirium and the adverse outcomes which include falls, dehydration, malnutrition and, in too many cases, death, delirium needs to be recognised early. It is here we need the help of community colleagues who are best placed to recognise early changes in people's behaviour.
When a person is "a bit muddled", "not themselves" or perhaps a bit sleepier than usual or not able to settle into their usual daily routine, this may be the first sign of delirium. These are essentially changes in the person's state of arousal due to a change in their medical condition. It is important that nurses and nursing assistants attending to people in their own homes, care homes and day centres are delirium aware and able to recognise these signs.
If swiftly escalated to someone who can complete an assessment, delirium could be identified and treated, averting further physical and cognitive decline and maybe preventing a fall or avoiding an unnecessary hospital attendance.
The RCN's Older Peoples' Forum, supported by My Improvement Network, has launched a Delirium Champions programme for community nurses to help raise awareness. Nurses and nursing assistants are asked to sign up to become delirium champions and are provided with resources to enable them to deliver awareness sessions to their teams and create escalation plans.
I would encourage you to sign up and join the other 1,000 nurses who have committed to being delirium champions. Not only will you receive a much sought-after pin badge with the slogan "Don’t Discount Delirium", you will also have the opportunity to attend our end of project evaluation and celebration event at RCN headquarters where you can meet other champions and share your case studies and experiences.
Look forward to meeting you at HQ.