Manic Delirium - Treatment Considerations

Abstract

Introduction: Delirium is a common and often overlooked disorder of cognition that is associated with increased morbidity and mortality. As there is little information in the literature regarding quality improvement for delirium care in the non-ICU setting, our goal was to design interventions to improve the prevention, diagnosis, and management of delirium in non-ICU patients. Methods: A Delirium Task Force was formed at the University of Kansas Hospital consisting of psychiatrists, geriatricians, a pharmacist, and multiple members in nursing leadership. As early intervention is correlated with the most favorable outcomes, we aimed to evaluate the use of antipsychotics in the management of delirium. We chose patients the day constant observation (CO) was initiated as a surrogate marker of patients with delirium and evaluated the use of antipsychotics the day of constant observation initiation. We excluded those who did not have delirium by the Confusion Assessment Method or who had alcohol withdrawal. Results: Twenty seven patients were identified during the data collection period. Median age was 65. Of 27 patients, 15 (56%) were given an antipsychotic, but only 9 (33%) were on a scheduled dose of antipsychotic. There was also a high incidence of offending medications (63%), mainly benzodiazepines. Conclusions: Treatment guidelines for delirium advocate commencing antipsychotics at low doses with judicious titration upwards and avoiding delirium provoking medications. To this effect, we have developed a delirium order set to prompt medication review and appropriate pharmacotherapy. Another set of interventions involve educating nurses and physicians. We plan to reassess and report our findings when the interventions are complete.