Quality standard

Quality statement 1: Assessing recent changes that may indicate delirium

Quality statement 1: Assessing recent changes that may indicate delirium

Quality statement

Adults newly admitted to hospital or long-term care who are at risk of delirium are assessed for recent changes that affect cognition, perception, physical function or social behaviour.

Rationale

The early detection of delirium is important, because it allows supportive care and treatment for reversible causes to be put in place as quickly as possible. People may already have delirium when they are admitted to hospital or to long-term care, so it is important to assess for any recent changes affecting cognition, perception, physical function or social behaviour that may indicate delirium. If possible, family members and carers of people at risk of delirium should be involved in identifying any changes.

Quality measures

Structure

Evidence of local arrangements to ensure that adults newly admitted to hospital or long-term care who are at risk of delirium are assessed for recent changes that affect cognition, perception, physical function or social behaviour.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from clinical protocols.

Process

Proportion of adults newly admitted to hospital or long-term care who are at risk of delirium who are assessed for recent changes that affect cognition, perception, physical function or social behaviour.

Numerator – the number in the denominator who are assessed for recent changes that affect cognition, perception, physical function or social behaviour.

Denominator – the number of adults newly admitted to hospital or long-term care who are at risk of delirium.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Detection of delirium.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as hospitals, residential care homes and nursing homes) ensure that guidance is available on changes that may indicate delirium, and that systems are in place to assess recent changes that affect cognition, perception, physical function or social behaviour in adults newly admitted to hospital or long-term care who are at risk of delirium.

Health and social care practitioners ensure that they assess adults newly admitted to hospital or long-term care who are at risk of delirium for recent changes that affect cognition, perception, physical function or social behaviour.

Commissioners (such as integrated care systems and local authorities) ensure that the hospitals and long-term care they commission can demonstrate (for example, by auditing current practice) that newly admitted adults who are at risk of delirium are assessed for recent changes that affect cognition, perception, physical function or social behaviour.

Adults admitted to hospital or to a residential care home or nursing home who are thought to be at risk of delirium are assessed to spot any recent changes that may show that they have delirium, such as to their ability to understand or make decisions, or to their physical and social behaviour. A person is at risk of delirium if any of the following apply: they are 65 or older, already have difficulties with memory or understanding (known as cognitive impairment), have dementia, have a broken hip or are seriously ill.

Source guidance

Delirium: prevention, diagnosis and management. NICE guideline CG103 (2010, updated 2023), recommendation 1.3.1

Definitions of terms used in this quality statement

Long-term care

Residential care provided in a home that may include skilled nursing care and help with everyday activities. This includes nursing homes and residential homes. [NICE's guideline on delirium, terms used in this guideline]

Adults at risk of delirium

If any of these risk factors is present, the person is at risk of delirium:

  • Age 65 years or older.

  • Cognitive impairment (past or present) and/or dementia. If cognitive impairment is suspected, confirm it using a standardised and validated cognitive impairment measure.

  • Current hip fracture.

  • Severe illness (a clinical condition that is deteriorating or is at risk of deterioration).

[NICE's guideline on delirium, recommendation 1.2.1]

Recent changes that affect cognition, perception, physical function or social behaviour

Recent (within hours or days) changes or fluctuations that may indicate delirium may be reported by the person at risk, or a carer or family member. The changes may affect:

  • Cognitive function: for example, worsened concentration, slow responses, confusion

  • Perception: for example, visual or auditory hallucinations.

  • Physical function: for example, reduced mobility, reduced movement, restlessness, agitation, changes in appetite, sleep disturbance.

  • Social behaviour: for example, difficulty engaging with or following requests, withdrawal, or alterations in communication, mood and/or attitude.

[Adapted from NICE's guideline on delirium, recommendation 1.3.1]

Equality and diversity considerations

A learning disability specialist nurse should be involved in assessing changes indicating delirium in adults with a learning disability who are at risk of delirium, to ensure that the person's specific needs are taken into account.