Greater Manchester Community Delirium Toolkit

The Greater Manchester community delirium toolkit is designed for health and social care staff to use in the community to help them identify and manage delirium in people over the age of 18 and not under the influence of drugs or alcohol. It is based on national evidence and includes resources for both clinicians and people with delirium and their families.

We piloted the toolkit in five localities, with urgent care/admission avoidance/intermediate care teams in 2020. This included seeking feedback on the Greater Manchester delirium leaflet (now available in ten languages – print, audio and video). We have incorporated the pilot findings and feedback in the final versions below. The intended benefits of the pilot were the early detection of delirium, improved outcomes, such as reduced hospital admission, and to provide information for patients and family members. The report from the pilot is available Greater Manchester Community Delirium Toolkit Pilot Report March 2021 (1) .

These community teams were able to safely manage 70% of the patients with  delirium at home thereby avoiding hospital admission.

Dr Emma Vardy and Helen Pratt, from our Dementia United team, are two of the three authors of an academic publication, that describes the development and outcomes of the community delirium toolkit pilot via the link here Delirium can be safely managed in the community through implementation of a community toolkit: a proof-of-concept pilot study | RCP Journals

Following this successful pilot we’ve been mapping the levels of adoption across Greater Manchester using the ‘Stages of Adoption’, taken from the Patient Safety Network. Health Innovation Manchester, Dementia United and the community teams/localities have developed a heat map which shows the locality-led adoption of the toolkit.

You can download our report: HEAT Map Highlighting locality-led adoption post pilot of the Greater Manchester delirium toolkit April 2022 This report reflects the stages of adoption that have taken place 2021-2022 as it includes the stages of adoption from Q1, Q2 and then Q4 as of April 2022.

The basis for the development of the toolkit was the Greater Manchester approach to delirium, which outlines Greater Manchester’s position on the recommendations for a person-centred pathway for those susceptible to delirium in all setting.

We’ve been in conversation with community colleagues who have been involved in either piloting or implementing the community delirium toolkit and have four films and a podcast available.

Download the Greater-Manchester-community-delirium-toolkit-contents August 2023

The individual documents which make up the toolkit can be found below, along with optional resources. The links will lead directly to the named documents.

  1. Key document 1 How to identify and manage delirium
  2. Key document 2 The 4AT assessment tool for delirium
  3. Key document 3. Greater Manchester community delirium TIME bundle
  4. Key document Greater Manchester Management of delirium guidance
  5. Greater Manchester Delirium Leaflet Short Version June 2023
  6. Greater Manchester Delirium Leaflet Long Version June 2023

We also have the shorter version of the leaflet available in sixteen languages. These are available as a downloadable document, an audio file and a video.  You can find them here

Optional resources:

  1. RESTORE2 (Recognises Early Soft Sign, Take Observations, Respond, Escalate)
  2. Abbey Pain Scale
  3. Greater Manchester nutrition and hydration material:
    1. Paper Weight Arm band can be used to indicate malnutrition
    2. Monitoring food, fluid intake, and oral hygiene
  4. Health Education England mouth care assessment guide
  5. Bristol Stool Chart
  6. West Essex CCG Anticholinergic side-effects and prescribing guidance
  7. Bury Urinalysis in Care Homes
  8. Eating, drinking and moving well:
    1. Greater Manchester Malnutrition and Hydration Programme Resources (ageuk.org.uk)
    2. Eating and drinking well – supporting people living with dementia
    3. Keep GM Moving: Moving more at home
  9. Alzheimer’s Society “This is Me” document

Guidance for the care of people living with frailty undergoing elective and emergency surgery The Centre for Perioperative Care, working in collaboration with the British Geriatrics Society, has published a Guideline for the care of people living with frailty undergoing elective and emergency surgery | British Geriatrics Society (bgs.org.uk) The guideline encompasses the whole perioperative pathway; which includes specific recommendations for the prevention, detection, assessment and management of delirium in Emergency Departments, preoperative outpatient departments, surgical wards and theatres as well for primary care referrers and transfers out of hospital.  The guideline has been written for healthcare professionals involved in delivering care throughout the pathway as well as for patients and their carers, managers and commissioners.

Contact Dementia United if you want to provide feedback or have any questions email: gmhscp.dementiaunited@nhs.net

Training resources

Click here to find a range of resources that provide useful learning for those using the Delirium Community Toolkit