Hospital delirium treatment: Continuation of antipsychotic therapy from the intensive care unit to discharge

• Published in: American journal of health-system pharmacy Vol. 72; no. 23 Suppl 3; pp. S133 - S139
• Main Authors: Flurie, Rachel W, Gonzales, Jeffrey P, Tata, Asha L, Millstein, Leah S, Gulati, Mangla
• Format: Journal Article
• Language: English
• Published: England Copyright American Society of Health-System Pharmacists, Inc. All rights reserved 01.12.2015; Oxford University Press
• Subjects: Adult; Aged; Antipsychotic agents; Antipsychotic Agents - therapeutic use; Care and treatment; Continuum of care; Critical Illness - psychology; Critical Illness - therapy; Delirium; Delirium - diagnosis; Delirium - drug therapy; Delirium - psychology; Dosage and administration; Drug therapy; Female; Humans; Intensive Care Units - trends; Male; Methods; Middle Aged; Patient Discharge - trends; Retrospective Studies; Treatment Outcome; United States
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp150474

PURPOSE.The rate of continuation of antipsychotics for the management of delirium during hospital transitions of care in a tertiary care medical center was investigated. METHODS.A retrospective chart review was conducted for adult patients admitted to the medical intensive care unit (MICU) between June 1, 2011, and May 31, 2012, who were initiated on antipsychotic therapy at least 24 hours before transfer out of the MICU. The primary outcome evaluated was the percentage of patients initiated on an antipsychotic in the MICU who were continued on therapy after transfer to a medical ward. Secondary outcomes included the appropriateness of continuing antipsychotic therapy during transitions of care and the percentage of patients continued on an antipsychotic after hospital discharge. RESULTS.Of the 87 patients who met the study inclusion criteria, 23 (26%) were continued on antipsychotic therapy after their transfer from the MICU to the medical ward. Of the 23 patients continued on antipsychotic therapy, 9 (39%) were discharged from the hospital with an antipsychotic. Fourteen of the 23 patients were eligible for assessment of inappropriate antipsychotic continuation upon transfer from the MICU. Of these 14 patients, 9 (64%) were inappropriately continued on an antipsychotic. Patients continued on antipsychotic therapy at hospital discharge were more likely to be discharged to a facility (rehabilitation, skilled nursing facility, or healthcare institution) (p = 0.049).Future areas for study should include (1) prospective analysis to understand the clinical decision-making of providers when treating delirium, (2) evaluation of the long-term impact of continuing antipsychotic therapy for delirium, and (3) ways to improve communication of medication regimens during transitions of care. Plans to reduce antipsychotic continuation could involve reassessing patients on the medical wards, improving documentation of the indication for use in the medical record, or developing protocols to taper off antipsychotics before patients are discharged from the hospital. CONCLUSION.The continuation of antipsychotics for the management of delirium during transitions of care was a common practice at a tertiary care medical center. Patients receiving antipsychotics for treatment of delirium in the MICU were inappropriately continued on these agents when transferred from the MICU to the medical floor or discharged from the hospital.