Delirium: challenges for clinical governance

Background Delirium is caused by pathophysiology but yet it presents as a disorder of cognition. It can be a transient phenomenon, and full recovery is common once the underlying cause has been diagnosed and treated. Evaluation Through key studies on prevalence, prevention and management of delirium, together with emerging results from doctoral study. Key issues: Delirium is an independent predictor of poor clinical outcomes as follows: a slower rate of recovery and poor functional recovery; prolonged time spent in hospital; increased likelihood of admission to a care home and re-admission to hospital and increased risk of mortality. In addition, aspects of daily care raise important clinical governance issues. Conclusions Delirium is an indicator of the quality of hospital care for older people. It impacts on key clinical outcomes and care process such as person-centred care, respect and dignity, and patient and staff safety. Implications for nursing management Delirium has been neglected and trivialized. Nurse managers are the key to initiating and giving continued support to evidence-based facility-wide strategies to prevent or decrease the impact of delirium.