Ontario Health’s Delirium Quality Standard provides guidance on the care for adults age 18 years or older who are at risk for delirium or who are experiencing symptoms of delirium. It includes people who are in the following care settings:
- Hospitals (including those in emergency departments, acute and critical care, complex continuing care facilities and rehabilitation hospitals, and preoperative clinics)
- Transitioning from hospital to home
- Long-term care homes
- Other home and community settings
The quality standard focuses on the identification, assessment, prevention, and management of delirium across all health care professions. The quality standard includes seven quality statements addressing areas that have high potential for improving the quality of care in Ontario for people who are at risk for delirium or who are experiencing symptoms of delirium.
Below is a sample of tools that may help you with the implementation of the quality statements in practice, organized according to purpose. Many of these tools will help to support multiple quality statements.
This list is not exhaustive. Are there other tools or resources you use? Do you have experience implementing these tools? If so, please use the comments section below to share!
- The Senior Friendly 7: Delirium Toolkit—a guide from the Regional Geriatric Program of Toronto that offers a range of information on delirium, including how to screen, detect, prevent, manage delirium in an acute care setting
- Senior Friendly Care (sfCare) Learning Series—a series of resources from the Regional Geriatric Program of Toronto and the Provincial Geriatrics Leadership Ontario that includes posters and patient handouts on delirium to help caregivers and health care providers provide excellent care for older adults, and is also available in French
- sfCare Getting Started Toolkit and the Delirium Senior Friendly Hospital Toolkit—resources from the Regional Geriatric Program of Toronto to support implementing a standardized process for interprofessional delirium screening, prevention, management, and monitoring. The toolkit is designed for hospitals, but many resources are applicable or adaptable across sectors
- Caregiving Strategies—a webpage from Provincial Geriatrics Leadership Ontario that includes information about delirium and links to other resources, including a Caregiving Strategies Handbook with a chapter on Changes in Thinking and Behaviour: Delirium
- Considerations for Preventing and Managing Delirium in Older Adults During the COVID-19 Pandemic, Across the Care Continuum—a guidance document from the Regional Program of Toronto for supporting older adults during the pandemic
Tools to Support Clinical Practice
The following tools and/or resources can support Quality Statement 2: Interventions to Prevent Delirium in the quality standard:
The following tools and/or resources can support Quality Statement 3: Early Screening for Delirium in the quality standard:
- Delirium Triage Screen (DTS)—a two-step delirium monitoring process for busy clinical environments, such as emergency departments. The DTS is a 10 to 20 second assessment designed to rapidly rule out delirium, consisting of two components: (1) a measure of level of consciousness, and (2) a brief measure of inattention
- Confusion Assessment Method Instruments—a list of validated instruments for the recognition and screening of delirium from the American Geriatrics Society CoCare: Hospital Elder Life Program, including (free to access with registration):
- Arousal, Attention, Abbreviated Mental Test 4, Acute change (4AT tool)—a screening instrument designed for rapid initial assessment of delirium and cognitive impairment that can be used outside of the ICU
- Intensive Care Delirium Screening Checklist (ICDSC)—an 8-item checklist of delirium symptoms evaluated over an 8–24 hour period that can be used in the intensive care unit, from the Alberta Health Services
Educational Opportunities for Health Care Professionals
Tools and Resources for Patients, Families, and Caregivers
- Quality Standards—other quality standards from the Clinical Institutes and Quality Programs portfolio within Ontario Health (formerly Health Quality Ontario) may also be useful, including:
Comment below to describe your experience with these tools or share any others you have found useful!