Quality Standard Details
Delirium: Care for Adults
- Publication Date
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2021-March-01
- Status
- Published
- Topic Area
- Mental Health and Addictions
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Delirium is an acute disorder of attention, awareness, and altered mental status. It develops over a short period of time (usually hours to a few days) and tends to fluctuate in severity during the course of a day. People with delirium can present with hypoactive or hyperactive forms. In the hypoactive form, people present as lethargic, withdrawn, and sleepy, and their delirium often goes unrecognized by clinicians and caregivers. The hyperactive form is characterized by restlessness, agitation, being hyperalert, and often hallucinations and delusions. Many people may fluctuate between the two forms (mixed delirium).
Delirium is very common in older people in the hospital setting: overall occurrence rates range from 29% to 64%. Delirium is an acute medical emergency that requires prompt recognition and treatment of underlying causes. Delirium has been identified as the third most common harmful event experienced by people admitted to Canadian hospitals. It has been associated with increased mortality across multiple care settings, including the emergency department, hospital acute care and intensive care units, and long-term care homes. Despite the obvious burdens to individuals and to the health care system, delirium is often unrecognized, misdiagnosed as another disorder, or misattributed to dementia.
This quality standard addresses care for adults age 18 years or older who are at risk for delirium or who are experiencing symptoms of delirium. It includes people who are in hospital (including emergency departments, acute and critical care, complex continuing care facilities and rehabilitation hospitals, and preoperative clinics), those transitioning from hospital to home, and those in long-term care homes and other community settings.
This quality standard focuses on the identification, assessment, prevention, and management of delirium across all health care professions.
Quality Standard in Brief
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Quality Statement 1: Identification of Risk Factors for Delirium
On initial contact with the health care system, people are assessed for risk factors for delirium, especially when they present to hospital or long-term care. Any risk factors for delirium are documented in their health record and at transitions in care, and are communicated to the person, their family and caregivers, and their health care team.
Quality Statement 2: Interventions to Prevent Delirium
People at risk for delirium receive interventions to prevent delirium that are tailored to their individual needs and care setting.
Quality Statement 3: Early Screening for Delirium
People presenting to hospital with any risk factors for delirium, or who have an acute change in behaviour or cognitive function during a hospital stay or in a long-term care home or in the community, are screened for delirium in a timely manner by a health care professional who is trained in screening for delirium using standardized, validated tools. The person and their family and caregivers are asked about any acute changes in the person’s behaviour or cognitive function.
Quality Statement 4: Education for People With Delirium, Family, and Caregivers
People who are at risk for delirium or who have delirium (as well as their family and caregivers) are offered education about delirium.
Quality Statement 5: Management of Delirium
Based on the results of a comprehensive assessment, people with delirium have a multicomponent interprofessional management plan to address the causes and manage the symptoms of delirium.
Quality Statement 6: Antipsychotic Medication
Only people who are in severe distress from symptoms of delirium or at immediate risk of harm to themselves or others are considered for antipsychotic medication use. These medications are always used in combination with first-line management strategies. If antipsychotic medication is started, it is reviewed daily and discontinued as soon as the clinical situation allows.
Quality Statement 7: Transitions in Care
At transitions in care, people with current or resolved delirium (as well as their family and caregivers) are given information related to delirium and its management. This information is communicated to those involved in the person’s circle of care and documented in the health record at transitions in care.
Supporting Documents
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Patient guide for this quality standard
Know what to ask for in your care
Placemat for this quality standard
A quick-reference resource for clinicians that summarizes the quality standard and includes links to helpful resources and tools
Quality improvement tools and resources for health care professionals, including an action plan template
Supplementary information to support the data collection and measurement process
The eReport is an online tool for hospitals. It allows you to access indicators that help enable quality improvement. The report is dynamic, and you can view data at the hospital and regional levels. You will need a ONE ID account to access the data.
Additional Resources
If you would like to receive these resources, please send us a message using our contact form:
- Case for improvement (slide deck)
Share why this standard was created and the data behind it, to get the support you need to put it into practice - Technical specifications
See the technical specifications for the indicators within the quality standard - Tools to support patient care
- Summary of the public feedback we received
- Case for improvement (slide deck)
Last Updated: February 24, 2026
