Preventing delirium – the basics, done consistently

About a third of delirium in hospital is preventable with consistent, unglamorous, multicomponent care. This page covers the non-ICU essentials – ward and care home – anchored to SIGN 157 and NICE guidance.

Every patient, every shift

• Orientationvisible clock and date; introduce yourself; explain where they are and why.
• Sensesglasses on, hearing aids in and working.
• Drinking and eatingsupport hydration and nutrition; watch swallowing.
• Movingmobilise early and regularly; avoid unnecessary catheters, cannulas and restraint.
• Sleepquiet, dark nights; avoid waking for non-essential observations; daylight and activity by day.
• Medicinesreview for deliriogenic drugs (especially anticholinergics, opioids, benzodiazepines) and for abrupt withdrawal, including alcohol.
• Familyinvolve them: familiar faces, orientation help, and the best source of baseline information.
• Illnesstreat infection, pain, constipation, urinary retention and dehydration promptly; they are precipitants as well as complications.

Who is at highest risk

Older age, dementia or prior cognitive impairment, frailty, sensory impairment, severe illness, hip fracture, polypharmacy. Target the checklist hardest at these patients.