In 2016 The Cheshire and Merseyside Palliative and End of Life Care Audit Group conducted an audit of the management of delirium in palliative care patients across settings. Willowbrook Hospice (a 12-bedded specialist palliative care unit) took part in this audit. The audit found that benzodiazepines were often used first line for the management of delirium which is not supported by the evidence from the literature. This was felt to be because some staff do not distinguish between agitation and delirium in the dying person. The audit group produced guidelines for the recognition, assessment and management of delirium and recommended the use of the Confusion Assessment Method as an assessment tool.
In response Willowbrook have developed a THINK DELIRIUM policy and accompanying Quick Reference Guide which takes a stepwise approach (similar to the WHO analgesic ladder) to delirium and agitation recognition, assessment and management. In addition we developed a teaching tool that could be delivered easily 1:1 or at daily handovers. All staff were updated over a period of a few weeks. Staff now report increased understanding of the differences between delirium and agitation and confidence in management. We are planning a second audit over the next few months.
This poster describes the THINK DELIRIUM project and the stepped approach to management including the outcome of further audit and a survey of the confidence of staff in recognising and management of delirium and agitation after the educational intervention