Here are the first ten tips that came to mind for the management of delirium in specialist palliative care.* Of course, there are many more to list. Please share your top tips in the comments.
- Keep people mobile as possible & try to conserve sleep-wake cycle (not sleeping all day).
- Monitor for constipation, urinary retention and pain.
- Get to know the person. Preferred name, likes and habits. Familiar faces help.
- Delirium is distressing to the person, family and staff. Educate, educate, educate.
- Use antipsychotics JUDICIOUSLY, only if non-pharmacological methods haven’t worked.
- Benzodiazepines worsen delirium. So do anticholinergics.
- It’s not all “terminal delirium” – don’t miss potentially reversible delirium.
- Delirium is commonly missed, misdiagnosed (eg as depression or dying) or mismanaged.
- Every bed move, especially after hours, increases risk of delirium. Common in hospitals.
- Check out
@meera_agar @AnnmarieHosie for Aussie research on delirium in palliative care.
*in 140 characters, the length of a ‘tweet’
For an introduction to delirium, see Monday’s post “Delirium: Why we should (palliative) care” for a great 5-minute video
For a personal account of caring for a loved one with delirium, plus links to the new Australian Delirium Clinical Care Standard, read Michael’s story, “The fear on his face was palpable”
If you’re a medical doctor and would like to learn more about delirium in palliative care from the experts (ie not me), check out the #ANZSPM16 Conference in Perth in Septembe
If you prefer audio, listen to a recent BMJ SoundCloud on Delirium & agitation at the end of life