Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- 1 Acute confusion: recognition
- 2 Antenatal and postnatal mental health
- 3 Attention-deficit hyperactivity disorder: provision of information
- 4 Bipolar depression: treatment
- 5 Bipolar disorder: management
- 6 Bipolar disorder: shared decision-making
- 7 Bipolar disorder: treatment
- 8 Chronic fatigue syndrome
- 9 Dementia: driving
- 10 Dementia: end-of-life care
- 11 Dementia: investigations
- 12 Depression: management in children and young people
- 13 Eating disorders: management
- 14 Epilepsy: management
- 15 Opiate dependence and pregnancy
- 16 Schizophrenia: family interventions
- 17 Schizophrenia: management
- 18 Schizophrenia: occupational achievements
- 19 Self-harm: assessment
- 20 Self-harm: assessment in children
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- Appendices
1 - Acute confusion: recognition
from I - Disorders
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- 1 Acute confusion: recognition
- 2 Antenatal and postnatal mental health
- 3 Attention-deficit hyperactivity disorder: provision of information
- 4 Bipolar depression: treatment
- 5 Bipolar disorder: management
- 6 Bipolar disorder: shared decision-making
- 7 Bipolar disorder: treatment
- 8 Chronic fatigue syndrome
- 9 Dementia: driving
- 10 Dementia: end-of-life care
- 11 Dementia: investigations
- 12 Depression: management in children and young people
- 13 Eating disorders: management
- 14 Epilepsy: management
- 15 Opiate dependence and pregnancy
- 16 Schizophrenia: family interventions
- 17 Schizophrenia: management
- 18 Schizophrenia: occupational achievements
- 19 Self-harm: assessment
- 20 Self-harm: assessment in children
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- Appendices
Summary
Setting
This audit would be most relevant to liaison psychiatry within a general hospital, especially wards with a relatively high proportion of admissions for an acute confusional state (ACS) (orthopaedics, acute medical admissions, medicine of the elderly, etc.).
Background
An ACS is defined as acute onset of new or worsened cognitive deficit with disturbed consciousness, preferably with evidence of causation by either a medical condition or the action or withdrawal of a substance. The Royal College of Physicians’ guidelines for the prevention, recognition and management of delirium in older people estimates that the condition affects up to 30% of older medical patients (Royal College of Physicians, 2006).
Acute confusion can have a range of serious underlying causes and is associated with a raised mortality rate. Confused patients stay in hospital significantly longer, are less able to comply with treatment and are less likely to return home.
Clinical recognition of acute confusion is poor, particularly for patients who become lethargic (the most common subtype). Identification of acutely confused patients is important, however, in order that they be appropriately investigated and any underlying causes treated. Among patients identified as being at risk of an ACS, the Royal College of Physicians (2006) estimates that the rate can be reduced by 30% by using appropriate preventative strategies.
Standards
Guidelines from the Royal College of Physicians (2006) recommend that:
ᐅ all patients aged over 65 be screened for confusion on admission, using the Abbreviated Mental Test (AMT) or the Mini Mental State Examination (MMSE)
ᐅ patients over 65 who are at increased risk of an ACS (older patients; the visually impaired; those with pre-existing confusion or physical frailty; those with polypharmacy, alcohol dependence or renal impairment; those who are on anticholinergic drugs or who are undergoing surgery) should be reassessed serially (the exact timing is not stipulated) with the AMT or MMSE.
The target is for all patients over 65 to be screened on admission and all highrisk patients to be re-screened by 1 week.
Method
Data collection
ᐅ A daily trip to the ward(s) audited was required. All patients admitted in the last 24 hours were identified.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 21 - 22Publisher: Royal College of PsychiatristsPrint publication year: 2011