Recording, handover and family communication

NICE recommends documenting changes that may indicate delirium in the person's record, and offering information to the person and their family or carers. Families should be encouraged to tell staff about sudden changes or fluctuations. Accurate records and clear handovers help recognise delirium early, not just document it afterwards.

Family members often notice when someone is "not themselves" before staff see the full picture. Their concerns should be taken seriously. Staff must pass observations on clearly across shifts so patterns are not lost when the person briefly appears better.

What good recording should include

• What changed: confusion, alertness, sleep, appetite, movement, hallucinations, mood or engagement.
• When it changed: sudden onset, time first noticed, and whether symptoms fluctuate.
• What may be contributing: pain, poor intake, constipation, recent illness, medicine changes, fall or transfer.
• What was done: who was told, what escalation route was used, and what advice was given.
• What family or carers reported: changes from baseline can be important clues.

Manager focus: discharge and continuity

Write enough that the next person can see the pattern. "Confused" on its own is rarely enough.