Confused patient

NICE recommends the 4AT to assess for delirium on general wards (CAM-ICU or ICDSC in critical care).

Look for hypoactive delirium too — withdrawn, slow, sleepy.

Act now

1
Treat reversible causes found.
2
Reorient and reassure; involve family; quiet, well-lit environment; glasses and hearing aids.
3
If distressed or at risk, de-escalate with verbal and non-verbal techniques first.

ABCDE and glucose. Is this new or a change from baseline? Ask family or carers.
Do a 4AT (see Calculators). Score ≥4 suggests delirium.
Causes: infection, drugs (opioids, anticholinergics, benzodiazepines, steroids), urinary retention, constipation, pain, hypoxia, dehydration, electrolyte disturbance, alcohol withdrawal, stroke, hypoglycaemia.

Bloods (FBC, U&E, Ca²⁺, LFTs, glucose, CRP, TFTs), urine (dip has limited value over 65), bladder scan, ECG, CXR; CT head if focal signs, fall or anticoagulated.

Only if de-escalation fails and the patient is distressed or a risk to themselves/others: consider short-term (usually up to 1 week) antipsychotic at the lowest dose, titrated cautiously.
Avoid antipsychotics in Parkinson's disease and dementia with Lewy bodies.
Document the delirium diagnosis and check capacity for any decisions.

Reduced GCS, focal neurology, seizures, or unsafe sedation needs: senior review.

Haloperidol and olanzapine are unlicensed for delirium in the UK — follow local policy; check QTc before haloperidol.

Review and stop deliriogenic drugs where possible.

Check the BNF and your local formulary before prescribing.

Written to current guidance (NICE CG103) · sources checked 14 Nov 2026. We watch NICE for updates weekly.

Sources (2)

Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026

For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.