15
Treatment
STEP 7: Implement multi-component non-pharmacologic
interventions
➤ Refer to Table 4.
STEP 8: Manage sleep/wake cycle
➤ Melatonin 3–5 mg PO QHS or ramelteon 8 mg PO QHS.
STEP 9: Treat the underlying causes (e.g. the medical
illness, pain, etc.)
STEP 10: Utilize non-pharmacologic approaches for
agitation (Refer to Appendix C)
STEP 11: For management of severe agitation or psychosis
begin a low dose antipsychotic; keep the dose
steady for 2 days and then taper off as soon as
possible
➤ Avoid benzodiazepines (BZDs) except in BZD or alcohol withdrawal.
➤ Refer to Appendix A for dosages, indications, and adverse drug
reactions. Also refer to Appendix B comparing relative adverse drug
reactions among antipsychotics.
Monitoring
STEP 12: Reevaluate for delirium with the CAM frequently
STEP 14: Adjust non-pharmacologic treatments and
medications as necessary
STEP 13: Minimize complications of delirium
• Falls
• Aspiration pneumonitis or pneumonia
• Pressure ulcers
• Malnutrition
• Dehydration
• Urinary retention
• Constipation
• Physical debility
• Functional decline
Information regarding PRN antipsychotic and PRN psychotropic medications can
be found in Appendix G with link to Centers for Medicare & Medicaid Services (CMS)
Guidance and F-Tag 758 Free from Unnecessary Psychotropic Meds/PRN Use.
