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Rate of delirium onset during hospitalization
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Delirium affects patient safety, patient experience, alternate level of care (ALC) rates, access, and flow. Delirium is associated with increased mortality in several care settings (emergency department, hospital care, and long-term care (LTC)) and prolonged length of stay in hospital (~8 days) (McCusker et al, 2003). Patients that develop delirium are 2.4 times more likely to be placed in LTC, which leads to longer wait times and a greater number of ALC days. Delirium is only recognized in about one-third of cases, so education and prevention strategies are critical to improving patient outcomes.
Hospitals interested in this topic are welcome to join the Delirium Aware Safer Healthcare (DASH) campaign. Launched in April 2024, this 3-year provincial campaign promotes awareness and strengthens the ability of hospital teams across Ontario to prevent, identify, and manage hospital-acquired delirium. Join the community of practice on Quorum (linked below), where you can find all previous webinars in support of the change ideas below.
Key Resources
Delirium Aware Safer Healthcare (DASH) ‒ Community of Practice
Provincial Geriatrics Leadership Ontario Quality Standard Implementation Guide
Change Ideas
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Exercise caution when prescribing certain medications (e.g., sedative-hypnotics, benzodiazepines, opioids)
- Reduce or eliminate prescribing listed medications that are known to increase risk of hospital- acquired delirium (when appropriate)
GeriMedRisk
Choosing Wisely webinar on reducing prescribing of sedative-hypnotics
Choosing Wisely Canada: Drowsy Feeling Lousy Toolkit
Choosing Wisely Canada toolkit ‒ Less Sedatives for Your Relatives
Create a sleep-friendly environment
- Create a sleep-friendly environment (e.g., staff education to offer culturally sensitive amenities to promote better sleep, reduce noise and lights, and engage patients and caregivers on education about sleep-friendly environment)
Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU - Adjust nursing workflows and reschedule the administration of nonessential medication, so that patients are not unnecessarily disturbed during typical sleep hours (e.g., between 10 p.m. and 6 a.m.)
Have environmental services reduce overnight noise and lighting
The Impact of Environmental Risk Factors on Delirium and Benefits of Noise and Light Modifications: A Scoping Review
Address delirium prevention and management strategies daily
- Incorporate discussions on delirium prevention, sleep, and use of sedatives
Importance of Huddles from the IHI
A Collaborative Approach to the Prevention and Management of Delirium: Webinar with Trillium Health Partners and RGP
PSW Pocket Guide for Delirium Identification
RGP -New Kid on the Delirium Screening Block
Delirium Triage Screening tool for Emergency Department
Alberta Health Services Tool - Confusion Assessment Method
Regional Geriatric Program of Toronto ‒ Delirium Micro-Learning for Acute Care McMaster Optimal Aging Portal – Delirium: Is Your Loved One at Risk?
Maintain wellness to prevent deconditioning
- Incorporate mobilization (e.g., up for meals, toileting), cognitive stimulation and orientation, ample hydration and proper nutrition into daily routines
The MOVE Program; An effective intervention to keep older adults physically active while in hospital
A Guide to Virtual Creative Engagement for Older Adults
Ontario’s Delirium Quality Standard Practical Implementation Guide
Hospital Elder Life Program
End PJ Paralysis
Engage and educate care partners on delirium prevention
- Enhance the nursing care during hospitalization by helping care partners learn about how mobilizing the patient, supporting cognitive stimulation and orientation, and providing hydration and proper nutrition can aid in delirium prevention.
Delirium detection questionnaire for caregivers (page 10 in the SF7 toolkit)
Delirium Prevention and Care with Older Adults pamphlet
Caregiving Strategies Handbook (All Languages) - Provincial Geriatrics Leadership Ontario
Resources for Older Adults and Caregivers, Regional Geriatric Program of Toronto
McMaster Optimal Aging Portal ‒ Delirium eLearning Modules
Adopt a diagnostic approach to identifying patients at high risk of acquiring delirium while in hospital
Typically, delirium is not the main reason for a patient's admission to an inpatient facility. Patients with hip fractures, cardiac disease, and COPD have an increased risk of hospital-acquired delirium.
- Identify which patients are at higher risk of acquiring delirium while hospitalized and target risk mitigation strategies to prevent delirium onset
Ontario Health’s Hip Fracture Quality Standard and placemat (a quick reference resource that summarizes the quality standard and includes links to helpful resources and tools)
Incorporate quality standard recommendations (e.g., delirium screening and multimodal analgesia) when creating preoperative and postoperative order sets.
Osteoporosis Canada position paper on geriatric hip fracture care standards
Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients
Ontario Health’s Chronic Obstructive Pulmonary Disease Quality Standard and placemat (a quick reference resource that summarizes the quality standard and includes links to helpful resources and tools.
University of Ottawa Heart Institute ‒ Navigating Delirium during Hospitalization: A Guide for Caregivers and Families
References
1. McCusker J, Cole MG, Dendukuri N, Belzile E. Does delirium increase hospital stay? J Am Geriatr Soc. 2003 Nov;51(11):1539–46.
2. Discharge Abstract Database, Fiscal year 2022
- Reduce or eliminate prescribing listed medications that are known to increase risk of hospital- acquired delirium (when appropriate)
Last Updated: August 26, 2026
