NICE have published a Delirium quality standard consisting of 5 statements that describe high quality care for adults with delirium and set out the quality of care patients should receive. ICUsteps, along with the British Geriatrics Society and the College of Emergency Medicine, is proud to endorse this quality standard.

Delirium is a name for acute confusion and can affect 70% or more of intensive care patients while critical ill.

The patient who is delirious is often experiencing a world that makes no sense to us but is very real to them. For instance they may:

  • not know they are in hospital
  • think they can see frightening animals
  • think they have been kidnapped
  • think staff are only pretending to be nurses
  • try to make sense of the noises around them and create a different explanation for them, so for instance if another patient is upset, they may think someone is being tortured

The main point is that the patient is absolutely convinced about the reality of the confused world they are in. It can be terrifying for them and very worrying for relatives.

Often a patient who is delirious will still recognise friends and family although they will not generally believe their reassurances. They will usually want to get out of bed and be taken home. Patients with delirium can find it very difficult to understand or retain information – so even if they appear to understand what is happening, or may be joining in a conversation, they may not remember what has just been said to them. Delirium can also fluctuate, one minute you will be having a normal conversation and next they will say something that makes no sense.

Dr. Valerie Page, Intensive Care Consultant and leading authority on intensive care delirium, welcomed the introduction of the quality standard.

National guidance on delirium is always welcome. The recently released NICE quality standard on delirium takes the NICE guidance and lists the standards expected of individual hospitals in the detection, prevention and management of delirium. They are all commendable aims and if followed should improve a number of outcomes.

Whether delirium can be prevented by the measures described I am not entirely convinced but put together they describe the clinical care we would like to see for all our patients, friends and family. They require resources. Another problem is a lack of options with patients who have delirium (because apart than treating the cause(s) there are none). I hope that these standards are of practical use to clinicians who directly care for patients at risk of delirium.

Dr. Valerie Page

Delirium and intensive care

You can find out more by reading our patient information supplement Delirium and intensive care, written by Dr. Page and ICUsteps.