Answer for question 4.38 is C. Delirium is a common, costly complication for hospitalized patients. It adds to length of stay, morbidity, and mortality. Often, patients at risk are not preemptively identified, and preventive techniques are seldom applied. The National Institute for Health and Clinical Excellence (NICE) has issued recommendations for prevention, diagnosis, and management of delirium, including the following: • Identify patients at risk of delirium (SOE=A). • Establish a multidisciplinary healthcare team to prevent and manage delirium (SOE=B). • Avoid moving the patient between different rooms and wards (SOE=B). • Ensure appropriate lighting, signage, and cognitive stimulation; encourage visits from family and friends (SOE=B). • Maintain hydration and avoid constipation (SOE=B). • Prevent and treat hypoxia and infections (SOE=B). • Encourage mobility with appropriate assistance and supervision (SOE=B). • Assess and manage pain and sensory impairment (SOE=B). • Review medications to determine whether any may increase risk of delirium (SOE=B). • Promote and maintain nutrition and sleep hygiene (SOE=B). Additional studies have shown that consultation from surgery to specialized medical teams that focus on the older patient can reduce the relative odds of dying 1 year after hospitalization to 0.69 (95% confidence interval: 0.57–0.83) (SOE=B). The other options are not included in current guidelines for preventing delirium.
Posted on: Thu, 03 Oct 2013 03:03:07 +0000