Clinical thinking about delirium
Delirium Words
Clinical thinking about delirium
Delirium Words covers all aspects of delirium, from clinical care to the science behind it. Most posts are by Professor Alasdair MacLullich, with occasional contributions from guest authors.
Families are often first to notice delirium, but they are rarely given a name for what is happening or a clear guide to what to do next.
The emergence and widespread adoption of the unvalidated CAM-Lite in EHR systems has created a patient-safety disaster by missing most delirium cases. We are now saddled with a widely-embedded, yet unofficial, unvalidated, and markedly inferior version of the original CAM that, in short, does not work. The evidence summarised in this blog indicates clearly that the CAM-Lite greatly under-detects delirium. Under-detection of delirium is associated with multiple negative consequences and, given the scale of delirium, this is one of the most impactful patient-safety issues in current healthcare across the world. We need to move beyond this blind alley and find better ways of serving our patients with delirium.
By Dr Sharmella Summan The doctors and nurses saved my life. The porter soothed my despairing soul. My family, despite my resistance, loved my heart back together.
Delirium care involves three main pillars: detection, treatment, and prevention. In this blog I provide a concise guide to the fundamentals of delirium care in adults outside of ICU settings.
What are your tool completion rates? What level of delirium are the tools detecting, and do they reflect the real rates of delirium? Only by closely measuring what we are doing can we tell if our hospitals are truly delirium-sensitive.
[1] Delirium can be a presenting feature of life-threatening illness, physiological disturbance or drug intoxication People with delirium often have serious, acute illness. In some cases the delirium is the presenting feature, with perhaps only a few other clues.
Something that I had initially found confusing in the field of delirium was the sheer number of tools that have been developed. A huge variety. And it was not always clear what each one was for and how it should be used.
