Delirium: challenges for clinical governance

BACKGROUND: Delirium is caused by pathophysiology but yet it presents as a disorder of cognition. It can be a transient phenomenon, and full recovery is common once the underlying cause has been diagnosed and treated. EVALUATION: Through key studies on prevalence, prevention and management of delirium, together with emerging results from doctoral study. KEY ISSUES: Delirium is an independent predictor of poor clinical outcomes as follows: a slower rate of recovery and poor functional recovery; prolonged time spent in hospital; increased likelihood of admission to a care home and re-admission to hospital and increased risk of mortality. In addition, aspects of daily care raise important clinical governance issues. CONCLUSIONS: Delirium is an indicator of the quality of hospital care for older people. It impacts on key clinical outcomes and care process such as person-centred care, respect and dignity, and patient and staff safety. IMPLICATIONS FOR NURSING MANAGEMENT: Delirium has been neglected and trivialized. Nurse managers are the key to initiating and giving continued support to evidence-based facility-wide strategies to prevent or decrease the impact of delirium.