Prescribing guidance for delirium

Delirium is commonly encountered as death approaches and is characterised by:

• fluctuating levels of confusion
• inattentiveness
• disorientation
• hallucinations
• agitation and restlessness

Patients should be assessed frequently using the confusion assessment method (CAM) to facilitate prompt identification of delirium.

Antipsychotic naïve

1. Prescribe an antipsychotic for persistent delirium
   Consider:
   • haloperidol - 0.5mg to 1mg SC PRN twice a day (PBS)
    
2. Assess effectiveness of administered medicine and continue administering antipsychotic as required
3. Observe for extrapyramidal side effects

Antipsychotic tolerant

1. Review current antipsychotic dose:
   • If the patient is unable to swallow, consider conversion to CSCI using syringe driver over 24hrs
   • If the patient only has a PRN oral or wafer antipsychotic convert to SC dose
2. Administer PRN antipsychotic dose
3. Assess effectiveness of administered medicine and continue administering antipsychotic as required
4. Observe for extrapyramidal side effects

Prescribing considerations

• Review patient regularly
• If greater than 3 doses of any PRN medicine are required over a 24 hour period, review and consider changes to medication and syringe driver orders
• Check availability of medicines through the patient’s usual pharmacy

The medicines listed throughout this app are in line with those endorsed by Caring at Home and the Australian and New Zealand Society of Palliative Medicine (ANZSPM) within the Community End-of-Life Medicines List (136kb pdf).

 

Page updated 19 July 2018