Key Actions

Key Actions for Care Teams

  • Simple preoperative screening for cognitive impairment and risk factors including prior history of confusion or disorientation.
  • Talk with patients about delirium through the provision of checklists covering risk factors and the promotion of orientation through hearing aids, glasses, importance of family/ friends’ bedside presence and reassurance.
  • Anesthetic sedative and analgesic drug choices, including medications to be avoided.
  • Medication recommendations might include:
    • Do not routinely give benzodiazepines as a presedative or sedation to patients 70 years and older; impact can be very long-lasting. If these drugs are given, document justification.
    • Use dexmedetomidine instead of opioids, benzodiazepines, and propofol in the ICU for sedation. Benzodiazepines should never be used for infusion.
    • Do not give diphenhydramine for sedation or sleep.
    • Remove meperidine from order sets.
    • Low-dose first- or second-generation antipsychotics (haloperidol or risperidone/olanzapine) only for delirium (not for prevention); never as a standing order and for agitated delirium only.
    • Distinguish agitation from pain or anxiety. If patient is delirious look for underlying causes, reorient, utilize family; use medication and restraint as a last resort.
  • Provide orientation program to include environmental cues (white boards) and support of sleep/wake cycles (timing of vital signs, blood draws, ear plugs, eye shades).

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