011 page
Clinical teams
Recognising delirium at the bedside
A compact prompt to establish baseline and assess arousal, attention and acute change.
For health, care and teaching staff
Delirium resources, ready for the next conversation.
A practical library of one-page downloads for clinical care, teaching and service improvement, with editable Word alternatives. Patient and family handouts are for staff to select, talk through and give to the people they support.
Medical students · start here
From noticing change to making a plan
A supervised learning path for placements, bedside teaching and revision. Use the sheets with a real or simulated case; they are not a substitute for local teaching, clinical supervision or patient-specific assessment.
By the end, you should be able to
- recognise acute change, fluctuation, inattention and altered arousal, including hypoactive delirium;
- explain what a 4AT result can and cannot establish;
- build a cause-directed, multidomain assessment and care plan.
Use the official current 4AT and user guide.
- 01Recognise the patternPDF ↓
Baseline, acute change, fluctuation, attention and arousal.
- 02Use the 4AT properlyPDF ↓
Screening supports assessment; it does not replace diagnosis.
- 03Search for causesPDF ↓
Look for urgent threats and interacting contributors.
- 04Build the treatment planPDF ↓
Treat causes while supporting physiology, function and distress.
Try a short case
An 82-year-old admitted with pneumonia is newly sleepy, eats little and gives slow answers. A relative says this is very different from yesterday. What should you notice, assess and communicate?
Discussion: Treat the collateral history as evidence of acute change; recognise a possible hypoactive presentation; check urgency and physiology; use the appropriate detection tool; arrange clinical assessment for multiple causes; and start cause-directed and supportive care. One quiet encounter cannot establish either recovery or a diagnosis by itself.
The download desk
Pick the guide that fits
Showing all 25 downloads
021 page
Clinical teams
A positive 4AT: what happens next?
The assessment, communication and care actions that should follow a positive screen.
031 page
Clinical teams
Finding triggers: a structured cause sweep
A systematic, patient-specific prompt for urgent threats and multiple concurrent causes.
041 page
Clinical teams
The daily multidomain delirium review
A ward-round structure for reviewing causes, physiology, medicines, function and distress together.
051 page
Nurses & care staff
Non-drug care: shift by shift
A nursing and support-worker checklist for needs that can change across every shift.
061 page
Clinical teams
Agitation or unmet need?
A two-minute needs sweep before escalation, with de-escalation and safety prompts.
071 page
Clinical teams
Preventing delirium from admission
A tailored multicomponent approach for people at risk, linked to named actions and review.
081 page
Clinical teams
Five essentials for the discharge summary
A practical prompt for diagnosis, course, causes, medicine changes and follow-up needs.
091 page
Clinical teams
Multidomain treatment of delirium
A whole-person treatment structure joining cause-directed care, physiology, function, distress and review.
101 page
Health & care staff
Hypoactive delirium: the quiet change
Recognition and response prompts for drowsiness, withdrawal, reduced movement and poor engagement.
111 page
Prescribers & pharmacists
Medicines and delirium
A safety-focused review prompt covering medicine changes, withdrawal, prescribing and stop plans.
121 page
Allied health professionals
Allied health, function and recovery
A practical prompt for baseline function, safe activity, participation, rehabilitation and transitions.
131 page
Community & care-home teams
Care-home and community response
What to notice, record, hand over and do when a new change develops outside hospital.
141 page
Managers & leaders
Is your hospital delirium-sensitive?
Eight leadership questions covering recognition, response, family partnership and recovery.
151 page
QI & service managers
Audit your delirium detection system
A measurement guide that looks beyond completion rates to cases found and action taken.
161 page
Patient & family handout
What is delirium?
A plain-language handout explaining sudden confusion, common signs and why prompt assessment matters.
171 page
Patient & family handout
Signs to notice - and what to do now
A handout for discussing what a family should do about a sudden change in thinking or behaviour.
181 page
Patient & family handout
Finding the triggers of delirium
A handout explaining what the team may look for and the information families can provide.
191 page
Patient & family handout
How delirium is treated
A handout for explaining treatment across causes, body function, comfort and recovery.
201 page
Patient & family handout
Helping to prevent delirium
A handout on practical steps supporting orientation, sleep, movement, intake and sensory needs.
211 page
Patient & family handout
How families can help at the bedside
A bedside handout on small, calm actions that can make care less confusing or frightening.
221 page
Patient & family handout
Delirium or dementia?
An at-a-glance handout, including why sudden change still needs urgent assessment.
231 page
Patient & family handout
What to say to the clinical team
A family handout with useful words for describing rapid change and raising concerns.
241 page
Patient & family handout
After delirium
A take-home handout on recovery, what to record and when to seek further advice.
251 page
Patient & family handout
Frightening beliefs or hallucinations
A handout on responding without arguing, reducing distress and sharing information with staff.
No exact match.
Try a shorter search, or choose another audience.
Use it well
A useful sheet starts a conversation
Choose the guide for the job, print at 100%, and add local contact details where needed. The Word alternatives are local-adaptation templates, not approved local policy. Talk patient and family handouts through rather than leaving them without context. These resources do not replace assessment or local policy.
- 1Choose the use
Clinical prompt, teaching aid, service tool or handout.
- 2Print, share or adapt
Use the A4 PDF unchanged, or adapt the Word template only after named local clinical review.
- 3Talk it through
Circle actions and note who owns them and when they will be reviewed.
Clinical publishing standard
- Current sourcesNICE, SIGN, NHS, NHS Inform, MHRA and the official 4AT.
- Clear scopeDesigned for staff; UK-focused education, not individual medical advice or a substitute for local guidance.
- Transparent productionDrafted from Professor MacLullich's source collection with AI assistance; human clinical release review is required.
- Version controlEvery download carries its version, status and source list; material changes trigger fresh review.
- InterestsProfessor MacLullich led development of the 4AT and reports no financial interest in its uptake.
- IndependentNo advertising, sponsorship or paywall; limited analytics that visitors can turn off.
Editorial, review and corrections policy
Version 0.9 resources and this website were last reviewed and updated 8 August 2026. This preview collection is awaiting final named human clinical review before use in patient care. Sources appear inside every PDF. Corrections can be sent via AlasdairMacLullich.com. The site is independently maintained and is not an official University of Edinburgh or NHS website. Word templates may be adapted for non-commercial clinical education after named local review; retain the source list, attribution, version and a clear record of local changes. Adaptation does not imply University or NHS endorsement.
Who, how and why
Who: the collection is authored and clinically edited by Professor Alasdair MacLullich. How: source material was drafted into concise staff resources with AI assistance, checked against the official sources listed in each download, and subjected to structured safety and accessibility review; final named human release review remains outstanding.Why: the resources are provided free of charge to support safer, clearer delirium conversations, teaching and service improvement.
Core sources: links open the current official guidance.