Delirium Clinical Care Standard

Conduct a delirium risk assessment in the pre-admission clinic or within 24 hours of presentation to hospital for admitted patients. Identify key risk factors that include any of the following:

• age ≥65 years (≥45 years for Aboriginal and Torres Strait Islander people)
• known cognitive impairment or diagnosed dementia
• a previous diagnosis of delirium
• a severe medical illness (a clinical condition that is deteriorating or is at risk of deterioration)
• current hip fracture.

Patients with any of these risk factors should receive a validated screening test for cognitive impairment, which is recognised as a significant risk factor for developing delirium. Conducting cognitive screening on presentation to hospital helps identify patients who should be assessed for delirium and enables monitoring for delirium onset during a hospital stay by providing a baseline measure. This also applies to patients with known cognitive impairment. Offer screening for cognitive impairment using a validated tool that is culturally appropriate. (See ‘Related resources’ tab.)

Assess the risk of delirium before a planned admission, particularly for surgical and procedural interventions. Patients and carers should be advised of their risk and potential consequences of developing delirium, to inform decision-making and consent and to help with management if delirium does develop.

When screening identifies probable cognitive impairment, clinical assessment for delirium is necessary (see Quality statement 4). Note that a positive score on a screening tool is not a diagnosis, but a prompt for further assessment, early intervention and early family involvement.

Ensure systems, policies and procedures are in place to identify risk of delirium within 24 hours of presentation, and to support routine screening of cognitive function for patients at risk of delirium who present to a health service and are admitted for care. A structured approach can improve detection rates. Identify and use a local delirium screening and assessment pathway. This includes ensuring the availability of locally agreed, validated delirium screening and cognitive screening tools that are appropriate to the cultural backgrounds of relevant communities and protocols for when they will be used. Ensure that the staff who use these tools are trained and competent in their use, and that workforce proficiency is maintained.

Ensure policies and procedures are in place to inform at-risk patients and their family or carer about the risk of delirium and to encourage participation in care.

Ensure pre-admission protocols and consent processes incorporate an assessment of the risk of delirium and discussion with the patient before surgery or another procedure, as part of their informed consent. The Commission’s Informed Consent in Health Care – Fact sheet for clinicians can direct clinicians in obtaining valid informed consent

When you come to hospital or are planning admission for a procedure or other treatment, your clinician will check if you have any of the risk factors for delirium. If so, you will be offered a short screening tool to see if you have problems with:

• your memory
• putting your thoughts together
• communicating with others.

In the screening tool, a clinician will ask you a series of questions. If you have any difficulties with these questions, you may be at risk of delirium. You and your carer or family will also be asked about any recent changes in your behaviour.

If you are planning surgery or a procedure and you are at risk of delirium, you will be advised about the risk and what this means for you. This can help you to make a decision about having the surgery or a procedure, especially if it is not essential.

The 4AT has been validated both for screening for cognitive impairment and delirium assessment:

• 4AT: Assessment test for delirium and cognitive impairment, is available in 17 languages

A range of other validated tools for screening for cognitive impairment are available – for example:

• Abbreviated Mental Test Score (AMTS), incorporated in the NSW Health Delirium Screen for Older Adults available from the Agency for Clinical Innovation
• Kimberly Indigenous Cognitive Assessment (KICA) tool, available from the Dementia Centre for Research Collaboration

See also:

• Screening and assessment tools for older people - Agency for Clinical Innovation, NSW
• Cognition measure and tools - Dementia Centre for Research Collaboration
• The Commission’s Informed Consent in Health Care – Fact sheet for clinicians.

Develop a delirium prevention plan, in partnership with the patient and family or carer, as part of a comprehensive care plan for those at risk of developing delirium.

Offer at-risk patients appropriate multicomponent interventions to prevent delirium, while considering clinical risk factors and the setting. Discuss the interventions being put in place and encourage family or carers to be involved (for example, to orient and reassure the patient). Ask the family or carer to alert the healthcare team to any changes in the patient’s mental or physical condition. Educate patients and family or carers about delirium before it occurs, to reduce distress if it does occur.

Monitor patients regularly, at least daily for changes in cognition and behaviour, and for clinical deterioration. Risk of delirium is increased post-operatively. Conduct medication reconciliation before patients are transferred between locations, or phases of care (such as before moving between wards or transferring to another facility).

Interventions for preventing delirium are listed below. These also apply to patients with delirium:

• Communicate clearly. Identify yourself and explain to the patient what is happening. You may need to repeat yourself.
• Use eye contact when culturally appropriate – for example, this may be viewed as disrespectful or aggressive in Aboriginal and Torres Strait Islander culture.
• Review medicines to identify any that may increase the risk of delirium and to discontinue them if appropriate.
• Reconcile medicines before any transfers of care.
• Perform mobilisation activities at least once or twice daily, and mobilise a patient early after a procedure.
• Sit out of bed for meals.
• Help patients who usually wear hearing or visual aids, and ensure that they are in good working order.
• Maintain optimal hydration and nutrition, and encourage or help the patient as necessary (confirm dentures are in place).
• Regulate bladder and bowel function.
• Regularly reorientate and reassure the patient.
• Avoid moving the person within and between wards.
• Use activities that help increase cognition – for example, reminiscence.
• Use non-pharmacotherapy measures to help promote sleep (such as relaxation techniques, and using earplugs in the intensive care unit [ICU]).
• Maintain a quiet environment.
• Make a clock and calendar available to the patient. This may be a clock on the wall or a familiar one from home.
• Provide lighting that is appropriate to the time of day.
• Use effective pain management. Assess pain regularly and provide pain relief strategies.
• Provide oxygen therapy where appropriate.

Ensure that policies, procedures and protocols are in place to enable clinicians to provide patients at risk of delirium with a set of preventive strategies and to conduct regular monitoring. Ensure processes are in place for clinicians to partner with patients and their family or carers when determining and implementing interventions. Ensure that staff are trained and competent in providing care to prevent and manage delirium. Identify and implement a format for prevention plans for high-risk patients.

Ensure that systems are in place for medication reconciliation to occur whenever patients are transferred between locations of care, especially when transferring out of ICU or before discharge. This is to reduce the inappropriate continuation of short-term medicines.

Ensure that policies and procedures support environmental care strategies, such as reducing noise and avoiding ward moves wherever possible for patients at risk of delirium or with delirium.

Ensure that equipment and devices, such as call bells, signs, calendars and clocks, are available to help orientate patients to decrease the risk of, or effectively manage, delirium.

If you are at risk of developing delirium, your clinicians will offer care to prevent it from happening. They may do things such as checking and changing your medicines, giving you more fluids or helping you stay as mobile as possible. Your family or carers will be encouraged to be involved in your care and will be given information about delirium and how to prevent it. You will also receive regular checks on your physical condition, thinking and memory (cognition).

Cognition is the ability to put your thoughts together and communicate them.

Some tools for assessing delirium may not be appropriate for repeat measurement and monitoring. Tools suitable for monitoring for incident delirium include:

• Confusion Assessment Method ICU (CAM-ICU)
• Delirium Observation Screening (DOS) scale (13-item)
• Recognising Acute Delirium as Part of Your Routine (RADAR)
• Modified Richmond Agitation-Sedation Scale (mRASS)
• Single Question in Delirium (SQiD)
• Nursing Delirium Screening Scale (Nu-DESC).

Other resources include:

• NSW ACI Aged Health Network: Care of Confused Hospitalised Older Persons (CHOPS)
• Canterbury District Health Board: THINK Delirium: Preventing delirium among older people in our care. Tips and strategies from the Older Persons’ Mental Health THINK Delirium Prevention Project.

that interventions for preventing delirium, such as modifying the environment, are in place and understood by the patient and their family or carer. Explain how they can help with prevention and management if they are able to do so.

Recognise when to engage an interpreting service to ensure the patient, families and carers understand the information you are sharing with them. Family or friends may not be appropriate interpreters because of health privacy issues.

If a patient develops delirium, proactively assess their distress and inform them and their family or carer about the plans to treat and reduce the severity of symptoms and any distress experienced with delirium. Support patients to make their own decisions and to choose a support person to be involved in decisions. Ask patients specifically about fears or concerns, and about hallucinations. Reassure patients and help them feel safe.⁴⁷ It can be reassuring to patients and their family or carer to know the clinicians are informed about delirium and will take steps to help them avoid it, or to recognise and treat it early if it occurs.

Recognise that delirium is often a frightening, distressing and isolating experience that requires a gentle and friendly approach for the patient and family or carer.

Ensure that systems are in place to support clinicians in providing person-centred care for those with, or at risk of, delirium. Consider flexible visiting arrangements to support family or carer involvement in delirium prevention and management.

Identify appropriate interpreting services and educate the workforce on how to use interpreters appropriately.

Ensure that systems are in place to recognise when a patient has cognitive impairment and to work with the person, families and carers in a safe, calm and respectful environment. 

Ensure that processes are in place for patients, carers or families to directly escalate care. Examples of good practice include the following:

• Ryan’s Rule is a three-step process in place in Queensland public hospitals to support patients, their families and carers, to raise concerns if a patient’s health condition is getting worse or not improving as well as expected.
• Call and Respond Early (CARE) (WA and ACT) is another example of allowing patients or their families and carers to call for rapid assistance when they feel that the healthcare team has not fully recognised the patient’s changing health condition.
• REACH (Recognise, Engage, Act, Call, Help is on its way) (NSW) is a patient and family escalation system developed by the NSW Clinical Excellence Commission for New South Wales hospitals.

If you are at risk of delirium, you and your family or carer will be given information and advice about delirium and how it can be prevented. You should be given this information in a way that you can understand it, whether it is written information or someone talking to you. Being prepared and acting early can help to reduce the effects of delirium. You and your family or carer will be encouraged to alert your healthcare team of any changes in your behaviour, thinking or physical condition. The health service organisation will have systems in place to take action if your health worsens. It is important that you and your family or carer know what to expect, what you can do if this happens and how to ask for help.

Your family or carer can provide valuable information to the clinicians caring for you and should be involved in your care if you wish them to be. An interpreter can be used for these conversations if required. If you develop delirium, the plan for your care will be discussed with you and your family or carer, and informed consent will be sought for any treatment you receive. The aim of your care will be to reduce your symptoms and any distress experienced with delirium.

People with delirium may:

• appear confused and forgetful
• be unable to pay attention
• be different from their normal selves
• be very agitated, quiet and withdrawn, sleepy, or a combination of these
• have rapid and unpredictable mood changes
• be unsure of the time of day or where they are
• have changes to their sleeping habits, such as staying awake at night and being drowsy during the daytime
• feel fearful, distressed, upset, irritable, angry or sad
• have hallucinations and see frightening things that are not there but seem very real to them
• lose control of their bladder or bowels
• have delusions or become paranoid, and strongly believe things that are not true – for example, they may believe that someone is trying to physically harm them or has poisoned their food.

These symptoms fluctuate during the day, and may worsen in the evening or night.

Family members or carers can support you because they are familiar to you. They can:

• reassure you
• remind you about eating and drinking
• bring in familiar objects
• help the healthcare team to get to know you and understand what you are normally like.

Examples of patient information about delirium can be found at:

• Agency for Clinical Innovation: delirium brochures, available in 15 languages
• Scottish Intercollegiate Guidelines Network (SIGN): Delirium: A booklet for people who have experienced delirium, and for their carers.

Using a validated tool, assess for delirium in:

• patients with cognitive impairment on presentation to hospital
• patients who have a sudden decline in cognitive function or change in behaviour during their hospital admission.

Seek information about the patient’s usual mental status from the patient or their family or carer, general practitioner, or other primary care provider or similar. Ask about behavioural changes, such as:

• confusion or worsened concentration
• agitation or restlessness
• sleepiness, including altered levels of consciousness
• whether the patient has been less communicative or less responsive than usual
• whether the patient has had difficulty cooperating with reasonable requests or has had other alterations in mood.

Family members or carers are often the best source of information about acute changes in a patient’s mental status or behaviour. As delirium symptoms can vary throughout the day, more than one assessment may be required to diagnose delirium.

Identifying hypoactive, hyperactive or mixed cases of delirium is necessary to implement appropriate treatment strategies. Hypoactive delirium is more common in older people, but is often missed and has a worse prognosis than other subtypes of delirium, including worse long-term cognition when delirium has a longer duration. Delirium is less likely to be recognised in patients with frailty or dementia.

Where delirium is detected, the diagnosis is determined and documented by a clinician working within their scope of practice. Document the diagnosis to aid in transfers of care, including in handover notes, referral and discharge letters. A history of delirium increases the risk of recurrence, and documenting an episode of delirium allows for preventive measures and monitoring for new delirium in subsequent healthcare encounters.

Discuss the diagnosis with the patient and their family or carer.

Current international clinical guidelines include validated delirium diagnostic tools, some of which require training to use the tool effectively.

Ensure that systems, policies and processes are in place to support clinicians who are assessing patients with suspected delirium. The policy should ensure that a locally agreed, validated diagnostic tool for delirium is available and that clinicians are competent in its use. Educate clinicians on the use of the tool, including specified training where required and according to the tool chosen.

Develop and implement protocols for escalating care when acute deterioration occurs.

Ensure that protocols are in place to support accurate documentation and coding of delirium. Monitor rates of delirium to enable quality improvement. Awareness of delirium prevalence can assist in the effective planning of services, such as the capacity for adequate resourcing, which may include specialist nurses.

If you are in hospital and your symptoms suggest that you may have delirium, a clinician will assess you to see if you have delirium. They may ask if you or your family or carer have noticed any recent changes in your thinking or behaviour, such as being confused or agitated, or quieter, sleepier or less communicative than usual. If a family member or carer notices any sudden change in your mental or physical condition, it is important for them to alert a clinician. The clinician will discuss your diagnosis with you and your family or carer, and write down your diagnosis of delirium in your healthcare record. This will help other clinicians to care for you.

Some examples of validated tools to assess for delirium include:

• 4AT – Assessment test for delirium and cognitive impairment
• Confusion Assessment Method (CAM)
• Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
• 3D-CAM
• Delirium Observation Screening (DOS) scale
• Delirium Rating Scale-Revised-98 (DRS-R-98)
• Memorial Delirium Assessment Scale (MDAS)
• Nursing Delirium Screening Scale (Nu-DESC).

See also: 

• Screening and assessment tools for older people - Agency for Clinical Innovation, NSW

Carry out a comprehensive assessment of the patient, in consultation with the patient and their family or carer, to identify possible causes of delirium. Seek a patient summary from the patient’s general practitioner to help inform the investigation.

A comprehensive assessment involves:

• a medical and social history, paying close attention to the patient’s medication history, including adverse reactions, their pain management needs, and their hydration and nutritional status
• a physical examination
• investigations, informed by the medical history and physical examination
• consultation with other clinicians with relevant expertise (such as a geriatrician, psychiatrist, dietitian), whenever possible. In rural and remote health services this could be facilitated by using telehealth when information technology systems allow.

Start treatment based on the cause when it can be identified. Ensure that the multicomponent interventions recommended for preventing delirium are also in place to manage delirium, including involving family or carers and modifying the environment (see Quality statement 2). Prevention is the most effective strategy, but outcomes for patients with delirium can also be improved by early intervention. Monitor patients regularly for changes in cognition and behaviour, including clinical deterioration.

Ensure that systems and processes are in place to support clinicians in identifying and treating the causes of delirium. Ensure that arrangements support multidisciplinary assessment, including telehealth consultation with clinicians, such as dietitian, nurse practitioner, geriatric medicine or psychiatry consultants when required.

Within a local health region, consider the hub-and-spoke organisation design model to support the provision of multidisciplinary assessment to rural and remote health services. The relationship between the larger hospital (hub) and the rural facility (spoke) could be structured to suit local arrangements, using information and communication technologies.

Provide regular training for staff on strategies to prevent and treat delirium.

If you are diagnosed with delirium, a clinician will carry out a medical check to identify what is causing the delirium and how best to treat it. You and your family or carer will be consulted as part of the assessment. This may include a physical examination, tests (such as blood or urine tests, chest X-ray), a check of the medicines you are taking and any recent changes to them, and checking whether you are in pain. You will receive treatments for anything that may be causing your delirium. For example, your medicines may be changed, you may be given more fluids or you may be given antibiotics if you have an infection.

If a patient has delirium, assess, monitor and document their risks of:

• functional decline
• falling and being harmed from a fall
• developing a pressure injury, dehydration or malnutrition.

Put in place interventions tailored to their risk, in consultation with other clinicians, the patient and their family or carer. Examples of interventions for falls prevention can include reorientation, appropriate lighting and ensuring that patients are using their eyeglasses or hearing aids. To lessen the risk of functional decline, encourage mobility and self-care with assistance as necessary.

Assist patients as required throughout the day to ensure that they maintain optimal nutrition and hydration. Ensure dentures are fitted correctly, particularly at mealtimes. For patients at risk of malnutrition, arrange for a dietitian to assess and manage them.

Ensure that systems and policies are in place to support clinicians to identify and manage the risk of functional decline, falls, pressure injuries, malnutrition, dehydration and other complications for patients with delirium. This includes implementation of the National Safety and Quality Health Service Standards (second edition).

Ensure that appropriate resources and equipment are available to decrease the risk of complications (such as low-rise beds for falls prevention).

If you have delirium, your care will include a plan to keep your physical health from getting worse while you are in hospital or another health service organisation. The plan includes ways to prevent falls and having an injury from a fall, such as wearing safe footwear or hip protectors, and care to prevent pressure injuries. You will be offered a nutritious diet to prevent malnutrition and dehydration. You will be encouraged to keep mobile. Your family or carers are encouraged to be involved in your care.

If a patient with delirium has severe behavioural or emotional disturbance:

• Investigate possible causes by conducting a comprehensive assessment that includes a medication review. Identify medicines that are known to contribute to delirium and adjust if appropriate, such as medicines with anticholinergic or sedative properties. Ensure that any medical causes for distress and agitation, such as pain, constipation, urinary retention and hypoxia, are treated.
• Reassure the patient and offer non-drug strategies – involving family or carers, if possible, or one-on-one nursing – to calm the patient and de-escalate the situation.
• Obtain information about the patient, their needs and preferences, and ways to reduce distress. If the patient cannot provide the information themselves, engage with family or carers, and use a structured tool such as the TOP 5 model.
• Ensure that the environment is safe for the patient and that noise is minimised, and the patient is observed without the staff invading their personal space.
• Use verbal and non-verbal techniques to de-escalate the situation, such as:
  • being respectful
  • introducing yourself and using their title rather than their given name if the patient does not know you
  • talking slowly and calmly
  • not disagreeing with the patient
  • asking questions and listening to the answers
  • expressing empathy and concern to show that you have understood
  • inclining your head slightly, to show you are listening and to give you a non-threatening posture
  • acknowledging their feelings and that the situation they find themselves in is frightening or distressing
  • providing a distraction.
• Avoid using physical or mechanical restraints, as they can increase agitation, prolong delirium and increase the risk of injury.

Evidence does not support the routine use of antipsychotics for treating delirium. However short-term antipsychotic use may be considered in limited circumstances – for instance, when non-drug strategies are unsuccessful and there is an imminent risk of the patient harming themselves or others. In such cases, assess the potential harms and benefits of prescribing an antipsychotic and, whenever possible, discuss the use of the medicine with the patient and family and obtain informed consent. Use the lowest appropriate dose for the shortest possible duration, as described in Therapeutic Guidelines: Psychotropic. A single dose is usually enough. When an antipsychotic medicine has been used in an emergency situation, discuss the use with the patient and their family or carer, so they understand why it was used.

If an antipsychotic is prescribed for a longer duration (more than a single dose), document the plan for the duration of therapy and the criteria for cessation – that is, the change in behaviour to be achieved. Advise the patient and their family or carer that longer-term use of antipsychotics has a greater risk of harm than of benefit, except in limited circumstances. Provide information on the process for review and monitoring the use of the medicine.

Arrange psychiatry or geriatric review for a patient with delirium who has other indications for antipsychotic use, or who has an existing prescription for antipsychotics.

Over-sedation can have serious consequences, such as dehydration, falls, respiratory depression, pneumonia and death. People with Parkinson’s disease or with Lewy body dementia are at an increased risk of severe adverse reactions from antipsychotics. Avoid benzodiazepines when managing delirium, as complications are common and long-acting benzodiazepines increase delirium.

Ensure that policies and systems are in place to treat delirium and to support using non-drug strategies as first-line therapy. The policies should include guidance about the non-drug strategies to be tried, evaluated and documented. These may include patient specialling (cohort care or one-on-one nursing), using specialist delirium/dementia care nurses with expertise in behaviour interventions, and involving family or carers. Provide regular training for clinicians on de-escalation techniques and other non-drug strategies.

Ensure that clinicians have access to guidance about:

• the potential harms of antipsychotic medicines and current recommendations for their use in delirium
• appropriate prescribing when there is an imminent risk of self-harm or harm to others, including the appropriate choice of antipsychotic, and dose and duration (such as described in Therapeutic Guidelines: Psychotropic).

Policies should describe the process followed for when an antipsychotic is being considered for a patient at risk of harming themselves or others. The process should include documenting:

• the non-drug strategies tried
• how the patient and family will be advised and provide informed consent
• the process for review, monitoring and cessation of the medicine, including review before discharge.

If antipsychotic use occurs in an emergency context, the policy should ensure that the patient and family or carer are advised.

Ensure that discharge communication to primary care clinicians and care providers, the patient and their family or carer is accurate, to prevent inadvertent continuation of antipsychotics used acutely.

Ensure that systems are in place to minimise the use of physical restraints, and that clinicians are educated in the appropriate use of restraints.

If you have delirium and you are distressed, your healthcare team will investigate what is causing your distress and reassure you, and address anything that is disturbing you, such as pain, discomfort or noise. Your family or carers will be encouraged to be involved in your care.

Antipsychotic medicines (such as the active ingredients quetiapine, olanzapine and risperidone*) are not usually recommended, because they do not help to treat the underlying cause of delirium and their side effects can result in serious harm. They may be considered if you are likely to harm yourself or others, and if it is not possible to reduce your distress in other ways. In this case, a clinician may discuss using an antipsychotic medicine at a low dose for a short time. A single dose may be enough. When an antipsychotic medicine is being considered for this reason, your clinician will discuss with you and your family or carer the choice of antipsychotic medicine, its side effects and benefits, dose, and how long you need to take it for.

Use of devices that restrict movement is avoided whenever possible.

* Antipsychotic medicines active ingredient names include: amisulpride, aripiprazole, asenapine, brexpiprazole, chlorpromazine, clozapine, droperidol, flupentixol, haloperidol, lurasidone, olanzapine, paliperidone, periciazine, quetiapine, risperidone, trifluoperazine, ziprasidone, and zuclopenthixol (Australian Medicines Handbook, July 2021)

Before the patient leaves hospital, develop an individualised comprehensive care plan with the patient and their family or carer, and provide them with information about delirium. In the plan, include the goals of care, strategies for managing persistent delirium, if present, and for preventing delirium recurrence. Include a plan for review by a specialist clinic, specialist or primary healthcare provider 10 days after discharge. Describe all ongoing treatments and any follow-up needed for any comorbidities. Arrange appropriate outpatient rehabilitation services when required. List all medicines that the patient needs to take, specifying the generic drug name, dose, reason for use and duration for each one. Explain why any medicines have been stopped or changed.

Advise the patient of ongoing support services in the community and provide contact details, as appropriate. Provide the care plan to the patient and their family or carer before they leave hospital and to their general practitioner, and other regular clinicians or care providers within 48 hours of the patient leaving hospital. Include information about any cognitive screening tests or assessment carried out in hospital, and when and where the patient should be reassessed, if appropriate. This is especially important for patients whose cognitive function may improve after discharge, to determine their ongoing level of function.

Ensure that systems, policies and procedures are in place for clinicians to provide information about delirium to patients and their family or carer, and to develop an individualised comprehensive care plan with the patient and family or carer before discharge. The care plan should include the details of cognitive screening tests or assessments that were conducted and arrangements for follow-up care post-discharge.

Ensure that systems enable the plan to be provided to the patient’s general practitioner and other regular clinicians and care providers within 48 hours of discharge. Where systems allow, enable uploading of the discharge care plan to the patient’s My Health Record. This enables other clinicians to access the details of the patient’s hospital care, which can be vital for informing ongoing care in the community. Sharing information on the care provided in hospital is particularly important if the patient is discharged to interim care (rehabilitation hospital or respite aged care) before returning home or consulting their usual general practitioner.

Before you leave hospital, a clinician will talk with you and your family or carer about your episode of delirium and the ongoing care you will need when you leave hospital. They will help develop a plan with you and your family or carer in a format that you understand. The plan sets out your goals of care and any extra care you need to stay well and avoid complications from delirium. This may include eating a nutritious diet and drinking enough water. The plan will describe ongoing treatments such as the medicines you need to take and if any medicines have been stopped or changed. It will also include any community support services you have been referred to. You will be given a copy of this plan before you leave hospital. Your general practitioner and other regular clinicians should receive a copy within two days of you leaving hospital.