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Delirium booklet and pathway reflect proactive approach

Resources on delirium developed by Waikato District Health Board will now be shared across the Midland health region. This includes a booklet that brings together nursing, allied health and medical information about preventing, recognising and managing delirium.

A delirium “map of medicine”, aligned with the existing dementia map, will also be developed as a Midland resource.

The Map of Medicine is an internationally recognised web-based system that brings together best-practice clinical pathways (maps) covering all major areas of healthcare. It supports decision making by any health professional. The pathways can be customised to reflect local needs. All five DHBs in the Midland health region (Waikato, Bay of Plenty, Lakes, Tairawhiti and Taranaki) and primary health organisations (PHOs) are collaborating to develop Midland Region NZ clinical pathways.

The decision to share the delirium resources was agreed at the first meeting of a Midland DHB regional delirium sub-group recently.  The group is now tasked with rolling out delirium resources and education across the five Midland DHBs.

Waikato DHB staff have already developed a delirium pathway for hospitalised patients which will become part of a wider Midland region delirium “map”.

Clinical trials provide evidence that at least 30 to 40 percent of delirium episodes in hospital may be preventable. Delirium is a physiological condition that can result from a medical condition or an event. Common symptoms are disorientation, hallucinations, agitation or apathy, rambling speech and disorganised behaviour. It can sometimes be mistaken for dementia but it is quite a different condition.

Photo: Waikato DHB leads for the delirium project Bel Macfie, nurse manager Older Persons and Rehabilitation, and Perrin Aish, nurse manager Acute Services.

Photo: Waikato DHB leads for the delirium project Bel Macfie, nurse manager Older Persons and Rehabilitation, and Perrin Aish, nurse manager Acute Services.

“We need to get a lot better at recognising and responding to delirium,” says Bel Macfie.

The updated booklet is based on a nursing resource prepared by nurse educator Chris Marra some years ago, with additions and updates including the delirium best practice pathway. The pathway sets out a comprehensive list of best practice interventions that should be implemented for patients experiencing delirium, including environmental, social and clinical aspects.

At the back of the booklet is a list of available resources. Among them is the Sunflower chart, a personalised “poster” that helps keep a patient with delirium focused on connections with the real world – the day’s date and reminders of familiar and favourite things.

“The Sunflower Chart is a fantastic resource for families, health professionals and carers, because it reminds us all to have conversations that help keep the person connected and grounded,” Bel Macfie says. “We know from the recollections of patients themselves that experiencing delirium can be frightening and confusing, and we how have techniques to manage it better in both clinical and non-clinical ways.”

 

 

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