Barnet Hospital's virtual ward for patients with delirium

What is delirium?

Delirium is a state of mental confusion which can come on suddenly. Patients can appear confused, agitated, and have difficulties with understanding and memory. It is most common in older people. Common symptoms are:

• Acute confusion
• Withdrawal, such as not taking part in usual activities or conversations.
• Restlessness (hyperactive)
• Drowsiness (hypoactive)
• Appetite changes
• Sleep disturbance
• Hallucinations
• Changes to mobility

What are the causes of delirium?

There are many causes of delirium including:

• Changes to someone’s environment.
• Infection.
• Constipation.
• Poor hydration.
• Lack of exercise.
• Changes to medications.
• Sleep disturbances.
• Pain.

It is commonly caused by more than one thing.

How is delirium treated?

Delirium is treated by identifying what the cause of the confusion is and addressing it. Every patient is different, some patients get better within hours and days, while for others it may take weeks or even months.

What is the virtual ward for patients with delirium?

The virtual ward is a joint service between the hospital, community, and social care teams. It allows patients with delirium to return to the comfort of their own home sooner, whilst remaining under the care of a consultant geriatrician at Barnet Hospital. It has been designed with patients in mind, using the latest emerging evidence, which shows that when someone is experiencing delirium their wellbeing improves much quicker at home compared to in hospital.

How will patients be cared for on the virtual ward?

Step 1

Before leaving the hospital, therapists from the ward will write an individual care plan that will be taken home with your loved one. Within one working day of returning home, they will receive a visit from the unplanned care team (community team) to make sure they have the support needed.

After one week, your loved one will have a follow-up appointment with the hospital consultant (on the phone or face-to-face) to see how they are progressing.

Step 2

Carers will regularly visit your loved one’s home to help support you in looking after them. The frequency of these visits will depend upon their needs.

Everyone involved in your loved one’s care (the multi-disciplinary team, which includes a consultant geriatrician, hospital and community therapists, carers from the social team and nurses) will also meet weekly to discuss their care needs.

Step 3

Please let the carers know if you have any questions or medical concerns, particularly if your notice a change in your loved one’s condition that is still present after 24 hours. Please see the contact details below.

Advice on caring for someone with delirium

It is important to know that someone who is experiencing delirium may be unable to remember you or your name, but it is very likely that they will remember the way you made them feel.

Coping with distressed behaviour

Delirium can make it difficult for someone to communicate how they are feeling, and this can lead to distressed behaviour.

In this situation, it can be helpful to try to work out what is causing the distress.

If your loved one is lashing out or is agitated, it may be because of one of the following reasons:

• They are in pain.
• They are too hot or too cold.
• They can’t remember where they are. In this situation, you can reassure them that they are safe and provide comfort.

If your loved one is withdrawn, tearful or depressed, it may be because they feel that they are lacking purpose. You can support them by trying to engage them in meaningful tasks and focusing on what they can do, instead of what they can’t.

Helping with eating and drinking

Sometimes people who experience delirium can have difficulties recognising food and drink or understanding what to do with it.

You can help them to eat and drink by doing the following:

• Set up mealtimes in the way that they are used to.
• If they are not hungry at traditional mealtimes adapt to what they need. For example, having a big breakfast if they are at their best first thing in the morning.
• Eat and drink with them as this can often help them have more.
• Make sure they can see and smell the food to help trigger their desire to eat.
• Support them to feed themselves where possible. Try putting your hand over theirs for assistance or serving finger food.
• Be patient and let them eat at their own pace.
• Try serving food ‘little and often’.
• Give them gentle reminders to eat – they may have forgotten that the food is in front of them.

Noticing changes

With delirium, your loved one’s behaviour may change over the course of a day, for example from being restless to then being withdrawn. However, if you notice any changes that last longer than 24 hours, please let the carers know and they will let the unplanned care team know.