"RECOGNIZING ACUTE DELIRIUM AS PART OF YOUR ROUTINE "

• Designated Principal
Investigator
• Philippe Voyer RN, Ph.D.
• Principal Investigator
• Nathalie Champoux M.D.
• Co-investigators
• Johanne Desrosiers OT, Ph.D.,
• Philippe Landreville Ph.D.,
• Jane McCusker M.D., DrPH,
• Johanne Monette M.D., M.Sc.,
• Maryse Savoie RN, M.Sc.

• Who: Nurses and nurse auxiliaries.
• When: During the distribution of medication, taking into account the patient’s behaviour since the last time medication was given.
• Where: Medication log
• Time to complete: 7 seconds
• Clientele targeted: Elderly patients, with or without dementia.
• Clinical settings targeted:
Acute care and long-term care settings.

" W H E N Y O U G A V E T H E P A T I E N T H I S / H E R M E D I C A T I O N , … "


Did he/she tend to fall asleep?

Did he/she have trouble staying awake?

FOLLOWING YOUR INSTRUCTIONS?

Did he/she take the medication when you gave it to him/her?
Elderly individual
 The person held out his/her hand.
 He/she brought the medication up to his/her mouth.
 He/she drank the water.
Elderly person with advanced cognitive impairment
 He/she opened his/her mouth.
 Did his/her eyes follow your movements and gestures as you were talking to him/her (made visual contact) ?

Did you have to repeat your instructions?


Was he/she moving slowly?
 Did he/she move slowly when he/she went to sit down, when walking, or when taking his/her medication?
 Tip:
 Compare the patient to a person of the same age in good health.

HOW TO WRITE UP YOUR OBSERVATIONS IN THE
RADAR TOOL

Philippe Voyer PV
√
PV
PV
PV

Philippe Voyer PV
√ PV
PV
PV

• The patient has slowed down. It takes her time to react, but she listens carefully to the instructions.
• The nurse does not have to repeat the instruction in spite of the slowness of movement.

• What exactly is drowsiness?
• A patient who is sleeping when you come into the room is not necessarily drowsy …
• If the patient wakes up easily when you speak to him/her or when you touch him/her, he/she is not drowsy.
• If the patient is fighting to stay awake, or dozes off again, despite your interactions with him/her, he/she is drowsy.

• In this situation, is it motor function slowdown or drowsiness?
• Don’t try to distinguish between them: check both of them on the RADAR form.

Philippe Voyer PV
√
PV
PV
PV

• The nurse had to tell the elderly patient several times to take the medication and the glass of water.

Philippe Voyer PV
√ PV
PV
PV

• The nurse has to tell the patient more than once to take her medication and the glass of water.

Philippe Voyer PV
√
PV
PV
PV

• The patient is disoriented in time and has memory problems. However, she is able to take her medication as soon as the nurse asks her to.
• The nurse doesn’t need to repeat the instructions.

STRATEGIES FOR FILLING OUT RADAR
CORRECTLY
• Many reasons can explain behaviour, but RADAR asks you to write down what you observe.
• Regardless of the reason for the observed behavior:
• The patient has such and such a disease.
• The patient slept badly.
• The patient is coming back from a test.

STRATEGIES FOR FILLING OUT RADAR
CORRECTLY
• There are many distractions when you give medication:
• Another patient is talking to you.
• A colleague just asked you a question.
• Something falls on the floor;
• Medication is handed out in the dining room where it’s noisy.
• Etc.

STRATEGIES FOR FILLING OUT RADAR
CORRECTLY
• Before entering the room, remind yourself of what you have to watch out for.
• In particular, do you have to repeat your instructions?

STRATEGIES FOR FILLING OUT RADAR
CORRECTLY
• Observation is done mainly during the distribution of medication
• But, if you have seen the patient since the last distribution you can take into account his/her behavior.
• For instance, if the patient is drowsy at 10 in the morning, but is no longer drowsy at lunch when you give medication, you should check "yes" for drowsiness.

STRATEGIES FOR FILLING OUT RADAR
CORRECTLY
• Last tip
• even if:
• the behavior is subtle.
• you have doubts about what you saw.
• the behavior has been present for days or weeks.
• Please check “yes” to the particular item of the
RADAR.

• Your participation in the process to detect delirium is essential.