Table 1 The dementia-friendly hospital program
Educational program for health practitioners | |
Digital educational electronic course | How patients with CI may experience hospital admission Detection of patients with CI and delirium Delirium-prevention treatment strategy and follow-up of CI |
‘Nurse-champions’ | Three local ‘nurse-champions’, on each ward |
Morning lecture | 30-min lecture for the ward physicians by a geriatric specialist |
Pocket-sized handouts | Visualizing the 4AT screening tool, the multi-component preventive interventions and delirium management suggestions |
Screening of cognitive impairment and delirium | |
4AT screening within 24 h after admission to the ward (If 4AT screening is not managed within 24 h, screening should be performed as soon as possible) | |
Interventions to prevent delirium | |
Orientation | Orienting communications |
Ensure patient has eyeglasses and hearing aids, if needed | |
Nutrition and hydration | Early recognition of dehydration and risk of malnutrition |
Encouragement of oral intake of fluids and encouragement during meals | |
Early correction of hypovolemia and electrolyte imbalance | |
Elimination | Prevent obstipation (e.g. encourage regular toilet routines) |
Early recognition of urinary retention (e.g. bladder scanning) | |
Mobilisation | Encourage daily mobilisation adapted to previous functional level |
Avoid restraints and immobilising equipment if possible (e.g. Foley catheters) | |
Sleep hygiene | Noise and light reduction at night |
Reschedule procedures to allow at least five hours of uninterrupted sleep at night | |
Cognitive stimulation to reduce sleeping during the day | |
Pain management | Assess nonverbal signs of pain |
Optimize pain management, preferably with nonopioid medications | |
Medications review | Review the patient’s medication list to reduce polypharmacy and to avoid any medications associated with precipitating delirium (e.g. benzodiazepines, antihistamines, high dose of opioids) |
Family involvement | Facilitate presence of relatives when giving important information to the patient |
Facilitate presence of relatives outside visits | |
Management of delirium | |
Identify and treat underlying causes | Search for infections, metabolic abnormalities and acute pain and treat as appropriate Assess polypharmacy and side effects of medications |
Reduce contributing factors and optimise orienting factors | Maintain preventive measures to optimise orientation and reduce contributing factors for delirium (e.g. stabilise vital abnormalities) |
Increase continuity of care by reducing number of nurses caring for patient | |
Place patient in single room if possible | |
Early assessment of need for 24-h nursing; facilitate the presence of relatives | |
Prevent complications | Prevent aspiration pneumonia, pressure sores, deep venous thrombosis and falls |
Pharmacological strategies | Procedure with preferred use of type and dosage of antipsychotics to manage severe agitation |
Manage sleep–wake cycle | |
Family involvement | Offer conversation with patients and relatives to inform them about delirium and follow-up after the delirium |
Cognitive assessment | Referral to assessment of cognitive function after discharge |