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Pharmacological management of the delirious patient with severe behavioural or emotional disturbanceIf the person is diagnosed with delirium is having severe behavioral or emotional disturbance, establish level of monitoring, address risk, reduce exacerbating factors and introduce containing measures. Ensure medical the cause of agitation such as pain, constipation, urinary retention or hypoxia are treated. Utilise non-pharmacological strategies to manage the symptoms, such as one-on-one nursing and patient support person.
If the symptoms ease, continue the use of non-pharmacological strategies and monitor status.
If the symptoms worsen or remain unchanged, assess the patient’s decision capacity, consider the use of antipsychotic medication, and continue with non-pharmacological strategies.
In the medication plan, consider issues of informed consent and document clear management plan, such as medication, maximum daily dose, frequency of titration, frequency of review, and components of review (such as level of agitation, total dose past 48 hours, side effects). If there are concerns about extrapyramidal side effects, has haloperidol or other antipsychotic medication such as olanzapine. Commence at low dosage, e.g. haloperidol 0.25mg orally; or if existing extrapyramidal signs olanzapine 2.5mg orally, or risperidone 0.25mg orally.
Continue ongoing monitoring of patient status by nursing staff or carers. Titrated antipsychotic medications need close monitoring by nursing and medical staff.
Review the patient status by medical physician.
If symptoms are better, continue with non-pharmacological strategies and monitor status.
If symptoms are worse or unchanged, go back to the medication plan to consider issues of informed consent and document clear management plan.
Adapted from: Clinical Epidemiology and Health Services Evaluation Unit 2006, Clinical Practice Guidelines for the Management of Delirium in Older People, Victorian Government Department of Human Services, Melbourne, Victoria