Hazel Miller, Consultant Geriatrician, Glasgow Royal Infirmary. Delirium enthusiast (or should that be delirium hater?) hoping she has earned the right to don a cape from time to time… Follow me on twitter @hazelmiller99
It’s fair to say that our understanding and management of delirium has increased hugely over the past ten years. It has gone from being the ultimate in Cinderella syndromes (unanticipated, undiagnosed, untreated, unexplained, unnoticed) to having high profile and energetic researchers and advocates (its own Delirium Superheroes). Everyone is being asked to Think Delirium these days.
And there are incredibly good reasons for this. Like the evil nemesis the superhero must repeatedly battle, delirium is terrible. It’s terribly common, it has a terrible impact on death rates, hospital complications and future cognition, it can be terrible to experience or to watch in a loved one. It even has terrible effects on utilisation of hospital bed days and nursing home placements. Yet despite this, the simple measures required to reduce the risk of it developing, and to detect and manage it, were being done terribly badly.
Scotland recognised early that when looking for “bang for buck” opportunities to improve health care, Delirium care stood out. Between our world class delirium researchers, our own dynamic and multidisciplinary Scottish Delirium Association (SDA) and the brilliantly innovative Healthcare Improvement Scotland THINK DELIRIUM improvement programme, which has engaged both the experts and clinicians at the coal face, we are leading the movement. Due to our patients’ vulnerability, teams working in older people’s physical and mental health have been key, but there is also an understanding and appreciation that delirium can be just as important for people in other types of care.
We should be extremely proud of what we have achieved, but the battle is far from won. Although our awareness and understanding of what should be done has been transformed, getting this knowledge reliably ingrained in everyday clinical practice still requires a great deal of work. Attitudes, expectations and ownership still need to change. Opportunities for anticipating and minimising risk of delirium still need to be broadened. Reduction and management of delirium outside the acute hospitals, both Care Home Delirium and delirium in people’s own homes, is still a major unmet need.
World Delirium Day 2017 (#WDD17) is a new initiative devised by iDelirium, the international federation of delirium societies. iDelirium will use WDD17 to promote its aims to:
- Advocate for delirium with a unified voice
- Build an understanding of the global economic implications of delirium
- Collaborate to advance delirium science
- Develop international programming for delirium
- Educate patients, caregivers, professionals, and policy makers about delirium
Scotland has embraced WDD17 as an opportunity to continue development, with local teams developing teaching sessions, competitions, information stands, posters and even a podcast. As well as coordinating this – look out for a delirium superhero coming to a hospital near you – and launching the Think Delirium Website, the SDA have identified 7 key themes for continued learning;
- Delirium care – Challenging stigma and transforming culture
- Delirium excellence starts in the classroom – Educating tomorrow’s professionals
- Delirium is everyone’s business – Multidisciplinary empowerment is the key
- Carers as partners – Encourage proactive involvement in Delirium care
- Working towards achieving excellence – Delirium care is everyone’s business
- Delivering better Delirium care – Right people with the right skills in the right place at the right time
- Delirium risk reduction – The key for better outcomes
So this Wednesday, WDD2017, take a minute to reflect. Reflect on how far we have come, but also on the journey ahead. Reflect on these seven themes and how can you apply them in your workplace. Reflect on how you can use the variety of resources that are available to you (see below). Reflect on what you can do in your own practice, but also on what you can do to influence and inspire others – a way of working that as geriatricians we are familiar with and skilled at. When you do this you’ll be channelling your internal Delirium Superhero – capes at the ready…!
- Scottish Delirium Association Website (contains links to management pathways and guidelines): http://www.scottishdeliriumassociation.com
- iDelirium Website (International Federation of Delirium Societies and home of WDD 2017): http://www.idelirium.org/home.html
- Think Delirium Website (in development):www.thinkdelirium.com
- Health Care Improvement Scotland OPAC website (links to THINK Delirium toolkit): http://www.healthcareimprovementscotland.org/our_work/person-centred_care/opac_improvement_programme.aspx