Quick Tools for Delirium Prevention and Management

There’s a handy free, downloadable pocket card published by the Canadian Coalition for Senior Mental Health (see link on the right hand side of page).  The fold-out card has several little pages. A few screen shots follow:

This is a nice simplified example of the nurse’s role and brief education since nurses won’t have time to read even a 20 page quick guide to delirium (see previous blog). It would also be useful for resident physicians. The summary of the CAM is succinct. The Key Messages about delirium is a handy little reminder about the critical facts to remember about delirium.

The Intervention to prevent delirium section above is a nice reminder for nurses about the non-pharmacologic multi-component strategy for preventing delirium. Nurses will never administer the Delirium Rating Scale R-98, which is designed to be used by psychiatrists. The Mini-Mental Status Examination (MMSE) has been criticized for not being in the public domain and it’s not brief enough. The CIWA-Ar or versions of it are in use in many hospitals, including ours. I think it’s excellent to mention that it’s necessary to use another cognitive assessment instrument in addition to the CAM. There are others besides the MMSE and a quick one is the Mini-cog that I’ve described in a previous blog. Another cognitive screening instrument to consider that is open access though copyrighted by Dr. Sharon Inouye is The Sweet 16[1].

This page is handy for resident physicians as a reminder that delirium is a medical emergency. It’s also a very good reminder of multi-component methods for managing delirium.

I suppose the drawback of pocket cards is that they tend to stay in the pocket gathering lint and ironically, reminder cards can be forgotten just as you can forget why you tied a string around your finger. But if you laminate a card like this one, it’s probably just thick enough to remind you it’s there. Taking it out and perusing it at least once a day would be a good habit to recommend as well.

All in all, I like the card and would use it myself (with a few alterations) and recommend it to non-psychiatric resident and attending physicians as well as nurses.

1.            Fong, T.G., S.R. Tulebaev, and S.K. Inouye, Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol, 2009. 5(4): p. 210-220.

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Comments

  1. Thanks for your help promoting our tools on delirium! Free downloads are available at http://www.ccsmh.ca or feel free to use the “contact us” button on our website to order hard copies.

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    • Greetings Kim,

      Many thanks to you and your group for making the goal of providing high quality medical care to seniors easier to reach!

      Best wishes,

      Jim Amos, MD

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