DELIRIUM-NON PHARMACOLOGICAL MANAGEMENT

SUMMARY

1. Simple measures:
- Ensure patient is well hydrated and nourished
- Treat constipation & urinary retention

- For elderly: ensure patient is wearing hearing aids and glasses
- Manage pain

2. Reduce the level of stimulation in the environment:
- Place patient in quiet, private room
- Remove noxious stimuli if possible—tubes, catheters, restraints, traction
- Limit unnecessary sounds—TV, radio, background conversations
- Limit number of visitors
- Staff to behave in a calm and reassuring manner
- Limit number and length of therapy sessions
- Provide therapies in patient room

3. Prevent harm to self or others:
- Place patient in a floor bed with padded side panels (Craig bed).
- Assign 1:1 or 1:2 sitter to observe patient and ensure safety.
- Avoid taking patient off unit.
- Place patient in locked ward.
- Use of equipment/devices: alarm and non-slip mats.

4. Reduce cognitive confusion:
- Deconstruct complex tasks into smaller steps
- Communicate with patient briefly and simply, one idea at a time
- One person speaking to patient at a time
- Maintain staff to work with patient
- Minimize contact with unfamiliar staff
- Reorient the patient frequently: placing an orientation board with date, location, placing a clock, photos of family members
- Bowel and bladder care: timed toileting, avoid constipation, avoid overflow incontinence by titrating fibre in diet and aperients

5. Tolerate restlessness when possible:
- Allow patient to thrash about in floor bed
- Allow patient to pace around unit with 1:1 supervision
- Allow confused patient to be verbally inappropriate

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].