Background Delirium may be reversible in up to 50% of patients with advanced cancer and the majority of patients who recover from delirium recall it as highly distressing.
Aims To retrospectively identify episodes of delirium in hospice inpatients and explore practice around consideration and management of potentially reversible causes.
Methods A retrospective review of all patients who were in-patients in the hospice during a two-week period was performed by searching electronic records for use of descriptors agreed by a group of healthcare professionals to be reasonable proxy terms for delirium. For each delirium episode the following were considered:
• Whether a diagnosis of delirium was made
• Whether the most likely cause was identified and addressed where appropriate.
Results 28 patients were included in the project with 38 episodes of delirium identified in total. A diagnosis of ‘delirium’ was made in 13 of these 38 episodes. In 23 of the 38 episodes a most likely cause was identified. An attempt was made to address the documented most likely cause in 16/23 cases. In seven this was either not possible or thought to be inappropriate due to the patient’s condition.
Discussion Proxy descriptors were used to identify delirium episodes. The use of proxy descriptors is likely to underestimate hypoactive delirium which is thought to represent the majority of delirium seen in hospice populations. It was more difficult to assess from descriptors of hypoactive delirium e.g., drowsy or sleepy if symptoms are related to delirium or to disease progression. A quality improvement project has been established to improve recognition and assessment of delirium. A validated screening tool has been introduced. Education has focused on prompt identification and active consideration of possible causes of delirium, and whether it is possible and appropriate to reverse these.
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