Delirium - Post discharge Delirium Follow Up Service
RefHelp - NHS Ayrshire and Arran
Delirium: An acute, and temporary, decline in mental functioning triggered by medical illness, trauma, surgery or drugs.
The SIGN 157 Risk reduction and management of delirium guideline (SIGN, 2019) recommends that all patients who have had delirium should be reviewed by the primary care team.
NHS Ayrshire & Arran’s Delirium Follow-up Service is a clinician led service which is run by NHS Ayrshire and Arran’s Delirium Nurse. The service is designed to support and compliment the range of primary care services which exist to support the follow-up care needs of older people who have experienced delirium whilst in hospital.
This standard operating procedure (SOP) aims to support those considering making a referral to the Delirium Follow-up Service by:
- Clarifying the patients for whom the Delirium Follow-up Service may be appropriate.
- Describing the process to follow in order to make a referral.
- Outlining the response of the Delirium Follow-up Service to any referrals received.
This SOP relates to all healthcare professionals within acute and community general hospitals in NHS Ayrshire and Arran who may make a referral to the service. This service is available throughout Ayrshire & Arran and referrals can be made when a discharge date is confirmed.
The Delirium Follow-Up Service accepts referrals for adults aged 65 and over who have a delirium diagnosis and no known history of dementia.
Referral criteria:
- Patient is aged 65 or over.
- Patient has no formal diagnosis of dementia.
- Patient has had an episode of delirium and all other differential diagnosis have been ruled out.
- The patient has been informed of the diagnosis and the diagnosis is documented on the discharge letter.
Referral process
- Complete The Delirium Follow-Up Service referral form and email to aa.deliriumfollowupservice@aapct.scot.nhs.uk
- On receipt of the referral form the delirium nurse will ensure that referral criteria is met and will advise the referrer if accepted. Please refer to Delirium Follow-Up Service care pathway.
- An appointment will be scheduled 12 weeks post delirium episode to allow for full resolution of the symptoms and of the underlying cause as per SIGN, 2019 recommendations.
- Referrer should provide patient with a Delirium Follow-Up Service leaflet which contains contact details for the delirium nurse.
The Delirium Follow Up Service care pathway
- An appointment is scheduled with the Delirium Nurse who will undertake a comprehensive assessment of physical and cognitive function.
- Education, emotional support and signposting to support services will be provided as per assessed need.
- A further follow up appointment will be offered if:
- There are ongoing concerns around incomplete resolution of delirium symptoms.
- Evidence of delirium induced psychological trauma.
- Or underlying progressive memory loss.
- If there is evidence of underlying progressive memory loss a further follow-up appointment will be offered within 12 weeks during which the delirium nurse will as appropriate undertake:
- Cognitive screening with aid of ACE-3.
- IQCODE testing with family member.
- Discuss referral to specialist services for further assessment/support.
- If the delirium follow up assessment indicates that there is full resolution of symptoms, no evidence of delirium induced psychological trauma and no concerns about underlying progressive memory loss the patient will be discharged.
- If, at any time during this process there are concerns regarding extreme stress and distress or evidence of risk to self or others the patient will be urgently referred to CMHTE.
SIGN 157: Risk Reduction and Management of Delirium (2019) [online] Edinburgh: Healthcare Improvement
Scotland. Available at: https://www.rightdecisions.scot.nhs.uk/risk-reduction-and-management-of-delirium-sign
Standards of Care for Dementia in Scotland (2011). Edinburgh: Scottish Government.