Background/Aim: One in four older people experience delirium during hospital, with significant consequences including distress, cognitive/functional decline (including dementia), longer hospital stays, residential aged care admission, and mortality. Despite the Delirium Clinical Care Standard, translation into practice is lacking and delirium is not adequately prevented, detected or treated. This study explored the barriers and enablers influencing healthcare practitioners’ ability to apply delirium knowledge in real-world clinical environments. Methods: A qualitative descriptive study was conducted using semi-structured interviews guided by the Theoretical Domains Framework. Healthcare practitioners who attended the Foundations of Delirium Workshop at the Australasian Delirium Association Conference (July 2025) were recruited. Results: Eight interviews were conducted with registered nurses (n=4), doctors (n=3) and a dietician. The overarching theme ‘Fragile equilibrium of delirium care’, was identified. Participants knew what care patients with delirium required but felt constrained by organisational culture and colleagues who did not view delirium as a medical emergency. Key enablers included visible leadership though designated Delirium Champions and interprofessional collaboration enabling shared ownership and communication. Barriers included time pressures, fragmented teamwork and communication. The emotional toll of delirium care contributed to burnout and moral injury, driven by repeated inability to provide optimal care within organisational, cultural and resource constraints. Conclusion/Implications: Effective delirium care requires balancing individual knowledge with supportive organisational and cultural conditions. Strengthening delirium leadership, improving interprofessional collaboration and addressing the emotional burden of care are critical. Implementation strategies must extend beyond education to address system level and cultural barriers to improve delirium care.