Delirium Workshop

1. Delirium Workshop Dr Mani Krishnan, consultant in old age psychiatry /liaison psychiatry and associate clinical director, mental health services for older people Teesside, Tees Esk Wear Valley NHS Foundation Trust (@psychinformatic) Amanda Davison (ANP) Clare Laverick (Assistant psychologist)

2. Delirium Workshop • Aims:- • To work together using a case study to identify challenges for services, individuals and families when caring for an individual with delirium • To identify what works well and what we could do better. • To understand how peoples needs are assessed in your own care setting?What are the challenges? What have you found works? • How can we support better transitions between care settings?

3. Delirium case study:- • Mrs. Smith is an 80 year old lady with dementia, hypertension, hypothyroidism, and osteoarthritis and constipation.  •  Mrs. Smith has been living in 24 hour residential care for 6 months as she wasn’t coping well at home and functional ability had declined, however she is fairly independent within the care home requiring minimal prompts. She enjoys the company of other residents and enjoys engaging in most activities in the care home. Her arthritis is fairly severe, causing her pain in the knees and hips when she walks.  •  Mrs. Smith recently experienced a fall in the care home and sustained a broken hip. She underwent hip surgery. Following the surgery was quiet and appeared to be sleeping for much of the day, she had not wanted to interact with family or friends when they visit and had not wanted to watch the TV soaps that she usually loves to keep up with. This presentation continues, the hospital staff assume that she is medically fit for discharge as she has made no complaints about pain and has been settled and calm and even sleeping during the day – she must be recovering – right?.  No concerns or problems regarding Mrs. Smith’s presentation were brought to the medical team’s attention and Mrs. Smith is discharged back to her residential care home (was a 4AT completed, was there a discussion with family we didn’t have any access to this information prior to discharge? • Sub text

4. Delirium case study:-HOWEVER, in the weeks following discharge back to the care home the care staff notice that Mrs. Smith is not her usual self, She is sleeping most of the day, when she wakes up she is vocal – crying out and this has increased over the week, staff are concerned that she may be in pain, she has co-codamol prescribed PRN, but Mrs. Smith does not ask for pain relief or tell staff that she is in pain, even when they ask. Prior to the fall Mrs. Smith had slept well and had a good routine however she is now quite restless and even agitated during the night.  She seems more withdrawn, her family is worried, and she isn’t herself. Could she be depressed? They don’t’ know how to help her and are concerned that she has “given up”. Family are concerned that the current care provider will not be able to support Mrs. Smith and they will need to find another care provider.The care home staff have been using co-codamol to try to ease the pain they believe she is in, but this is not given regularly and it doesn’t seem to be helping much. The care home ring the community mental health team (ICLS) for support as they believe that Mrs. Smith’s dementia has deteriorated and they need support to manage the agitation at night.

5. Delirium workshop In your groups please could you use the case study to think about and talk through the following questions could you write down your thoughts so we can talk through them together :- • What were the challenges within this case study?  For the services?  For the individual and their family? • What worked well?  • What could have been done better? 

6. Delirium workshop:- In your groups please could you use the case study to think about and talk through the following questions could you write down your thoughts so we can talk through them together :- • How do you assess people’s needs in your own care setting? • What are the challenges? • What have you found works?

7. Delirium Workshop Now using all of the thoughts we have had and conversations we have heard can you think about - • How can we support better transitions between care settings?

8. Delirium Workshop • Thank you • Any questions?