1. 1st Line Medication Lorazepam 0.5 mg p.o/i.m
Pharmacological management of delirium in Frail/ Older Adults: Action Card for administration of benzodiazepines
The use of sedatives and anti – psychotic medication should be kept to a minimum.
Sedation should only be considered once other strategies have failed to calm the patient such as distraction/diversion strategies, using 1:1 special to care for the patient. These can be found on the delirium in frail/older people intranet page.
Frail/Older adults refers to patients assessed as Rockwood 5 or above (see single clerking proforma)
Senior advice from a consultant or specialist registrar should be requested before starting patients on ORAL/ INTRAMUSCULAR sedatives and MUST be sought before prescribing INTRAVENOUS sedation. CONSIDER NEED FOR MET CALL.
Critical Care Outreach or Clinical Site Management Team (out of hours) must be contacted if intravenous sedation is required.
1st Line Medication Lorazepam 0.5 mg p.o/i.m
Patients who require special attention when administering benzodiazepines:
Cardio/ respiratory patients;
Neurological disease (including history of seizures);
Hepatic AND RENAL disease;
Not previously been exposed to neuroleptics.
Assess the Patient. Administering sedatives MUST be your last option to calm the patient down. Seek senior advice and Think: Do you need more help?
Be aware! When administering sedatives it MUST be started at the lowest possible dose. Always seek senior advice. A second dose may be considered after 2 hours only after further senior medical review and there remains a clear indication. Max dose Lorazepam 2mg/24hours.
2nd Line Medication Haloperidol 0.5 mg p.o/i.m. Max dose Haloperidol 5mg/24 hours. Avoid Haloperidol in patients with prolonged QTc and in Parkinson’s Disease & Lewy Body Dementia
Intravenous sedation can cause respiratory compromise, decreased level of consciousness and risk of aspiration, respiratory arrest and cardiac arrest.
Closely monitor and record physiological observations (Pulse, blood pressure, respiratory rate and oxygen saturations) by a Trained Nurse following administration of intravenous sedation. Observations should be recorded every 15 minutes in the first hour and at 30 minutes intervals for the second hour and when NEWS stable (4 or less) can be recorded hourly. If difficult to obtain observations e.g. Patient is refusing, then no contact observations must be done – respiratory rate and level of consciousness, please document this and the rationale for this and inform the Nurse in Charge.
This observational protocol must be followed after each individual dose of sedation is administered.
Escalate concerns using SBAR tool and consider MET call if necessary.
Document everything in the patient’s notes.
This action card is linked with policy C055 Managing Delirium in Frail/Older People and Microguide guideline 'Delirium in Frail/older patients‘
This document was ratified by the Trust Drugs and Therapeutics Committee December 7th 2017.