Exam Pass Notes

Use these notes for a final review before the assessment. They summarise the course's main practical points but do not replace local delirium pathways, emergency procedures, role-boundary guidance or the person's current care plan.

Download (Word)

Core messages

• Delirium is an acute confusional state with sudden onset and fluctuation, typically developing over hours or days.
• It is distinct from ordinary ageing and from gradual dementia progression.
• A person can have dementia and delirium at the same time. If you cannot tell which is which, address the delirium first.
• Delirium may be hyperactive, hypoactive or mixed. Quiet withdrawal can be as important as agitation.
• Risk factors highlighted in NICE guidance include older age, dementia or other cognitive impairment, hip fracture and severe illness.

Common triggers and prevention basics

• Typical triggers include infection, pain, dehydration, poor intake, constipation, medication effects, injury and acute illness.
• Prevention measures include consistent staff, avoiding unnecessary room moves, orientation aids, adequate fluids, encouraging mobility, reviewing pain, ensuring glasses and hearing aids are used, good nutrition and better sleep conditions.
• Ensure walking aids are accessible and note sudden reductions in movement or appetite.
• Family and carers can provide baseline information and should be listened to.

Role boundaries and escalation

• Sudden confusion needs urgent escalation within the same shift.
• Frontline staff should describe the pattern and triggers clearly and avoid diagnosing.
• If locally trained and authorised, a competent practitioner may use the 4AT, but final diagnosis requires appropriate healthcare expertise.
• De-escalation, reassurance and calm communication come before any consideration of sedation. Antipsychotics are not a routine first-line treatment.
• Record what changed, when it changed, possible contributing factors, who was informed and what happened next.

For the exam, remember the safe-practice sequence: recognise sudden change, compare with baseline, do the basics well, escalate urgently and record clearly.