Evidence-based clinical practice guidelines: Delirium management in hospitalized older patients

Background: The health problems of hospitalized older patients are complicated, with delirium a common neurocognitive disorder in this population. Delirium has been correlated with the longer periods of hospitalization, higher mortality, and higher rates of institutionalization. However, clinical practice guidelines for delirium management in hospitalized older patients are lacking. Purpose: The purpose of this study was to develop evidence-based practice guidelines for delirium management in hospitalized older patients. Methods: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members reviewed current delirium practice guidelines. A revised set of practice guidelines was developed by constructing foreground questions on key issues and by systematically searching, appraising, and synthesizing the relevant evidence. After a new draft of the guidelines was established, the Delphi method was used to reach a consensus among experts. Finally, the developed guideline document was applied in a geriatric ward of a medical center in order to evaluate applicability. Results: The developed delirium guidelines address 3 issues with 35 recommendations. The panel of clinical and methodological experts recommended that these delirium guidelines be applied in practice. Most nurses in the targeted geriatric ward indicated that the guidelines were feasible and easy to implement. However, several of the procedures were identified as difficult to implement, including “provide a therapeutic environment”, “promote good sleep patterns and sleep hygiene”, and “consider psychotropic medication as a last resort for agitation”. Conclusion/Implications for Practice: The evidence-based delirium management guidelines for hospitalized older patients that were developed in this study integrates the recommendations from the best available evidence and earned a high consensus among clinical experts. Thus, these guidelines are recommended for clinical application.