Delirium Risk Screening Tool

Purpose

The Delirium Risk Screening Tool allows nurses in long term care to identify residents who are at increased risk of developing delirium. This tool predicts the future development of delirium among cognitively impaired residents initially without delirium. It comprises 5 items that are either already known to nursing staff or that can be easily completed by consulting the resident's chart.

Example of the Delirium Risk Screening Tool

The screening tool is included as part of a comprehensive Delirium Prevention Program developed for nurses and nursing aids who work in long term care centres. Following Risk Screening, a more comprehensive Evaluation of Modifiable Risk Factors is recommended as part of the program Decision Tree. The program also includes a series of integrated nursing tools to reduce the incidence of delirium among cognitively impaired residents in long term care. See further below to download these tools.

Evidence

Read more about the program and its development in this short dissemination report, which includes a series of published references.

Material to download

The Decision Tree

The core tool in the Delirium Prevention Program is the Decision Tree including the Delirium Risk Screening Tool and the Evaluation of Modifiable Risk Factors. Download a copy of the Decision Tree.

The Evaluation Guide and Intervention Guide

The team developed an Evaluation and Intervention Guide to help nurses through the evaluation of the 4 modifiable risk factors and the selection of specific intervention to reduce them.

Download the guide for detailed instructions on completing the second part of the Decision Tree

The PowerPoint presentation for training

The program is accompanied by a PowerPoint presentation which can be used to train nurses and nursing aids on the Delirium Prevention Program. Each slide in the presentation includes a suggested script (see notes with each slide) that may be used by the trainer.

For tips on successful implementation of the program, read the last sections of the dissemination report.

Training Video

Presented by researcher Philippe Voyer and describing the Delirium Prevention Program.

Training Video (in French)

Additional tools

We have prepared a number of additional tools that can be placed in the nursing station.

An information pamphlet on delirium

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