Treating delirium: PINCHH-ME

Pain

  • Optimise pain control

  • Consider starting empirical paracetamol

Infection

  • Treat the most likley source of infection if there are signs or investigations in keeping with infection

  • Consider:

    • Chest

    • Biliary

    • Urine

    • Viral

    • Gut

Immobility

  • Encourage sitting out

  • Ask PT to see

Nutrition

  • Start food chart

  • Refer to dietician

  • Consider NG?

Constipation

  • Start bowel chart

  • Prescribe laxatives

Hydration

  • Prescribe oral fluids if required

  • Consider IV fluids

Head injury

  • Consider a CT head, especially if on anticoagulants

Medication

  • Consider stopping (or weaning) medications, especially:

    • Opiates

    • Tricyclics (eg amitryptyline)

    • Sedatives

Environment

  • Consider 1:1

  • Orientate and reassure the patient

  • Involve family

  • Ensure has glasses and working hearing aids

  • Stimulating activities – dementia specialist nurse can help