ICD coding is inadequate to determine in hospital delirium incidence. Instead, a point prevalence detection of delirium using the methods described above could be used. Health services could apply the described survey method to evaluate their local initiatives for the improvement of delirium detection and prevention. This article is protected by copyright. All rights reserved.

Objective To investigate whether physical training (alone or in a multi‐component intervention) is effective in preventing delirium or improving outcomes for adult patients with delirium in the hospital setting. Methods A systematic review, qualitative synthesis and meta‐analysis of randomised controlled trials identified by searches of electronic databases, combining key concepts of delirium and physical training (the target intervention). Outcomes were incidence of delirium (for prevention trials) and delirium duration, delirium severity and hospital outcomes (for management trials). Results Seven trials were included, five of which were multi‐component. The odds of developing delirium were lower for patients who received physical training compared with a control intervention [odds ratio 0.46 (95% confidence interval 0.32‐0.65), P < 0.01] (moderate‐quality evidence). There was insufficient evidence to draw conclusions about managing established delirium. Conclusions Strategies incorporating physical training appear to prevent delirium in the hospital setting. More research is required regarding management of established delirium.

Inappropriate benzodiazepine dosing in patients exhibiting signs of alcohol withdrawal cause staff and patient safety problems. Our primary goal was to develop an alcohol withdrawal protocol based on objective measures, and then to coordinate benzodiazepine dosing with those measures and improve care of the patient withdrawing from alcohol. A secondary goal was to give the primary care nurse the flexibility to administer benzodiazepine doses as needed to improve patient and staff safety. We developed and implemented a modified version of a published withdrawal symptomatology scale; a corresponding scale was developed for benzodiazepine dosing by observing the usual lorazepam doses needed to control withdrawal symptoms. Both scales and care guidelines for the patient withdrawing from alcohol were organized in the form of preprinted orders. Since implementation of the alcohol withdrawal protocol, complaints regarding patient and staff safety have decreased. Other patient care units are beginning to use the protocol. A hospital-wide task force is developing patient care plans based on the protocol for all patients withdrawing from alcohol.