Randy Hollins, PharmD, BCCCP
Clinical Pharmacist
Tufts Medical Center, United States
Disclosure information not submitted.
Ibrahim Chowdhury, PharmD
Clinical Pharmacist
Tufts Medical Center
Disclosure information not submitted.
Title: Evaluating Inappropriate Continuation of Psychotropic Agents upon Discharge
Introduction: Long-term use of psychotropic agents increases the potential for adverse effects and inappropriate medication continuation. The purpose of this study is to investigate the rate at which psychotropic agents newly initiated in the intensive care unit for the treatment of delirium are inappropriately continued upon hospital discharge.
Methods: This was a single-center retrospective analysis of adult patients admitted to an intensive care unit at a tertiary, academic medical center between January 1, 2017 and September 30, 2020. Patients discharged on a psychotropic agent who scored negative on the Confusion Assessment Method for Intensive Care Unit prior to discharge were considered to be inappropriately continued on therapy. The primary outcome was the incidence of inappropriate psychotropic therapy continuation at discharge.
Results: Of the 112 patients who met inclusion criteria, 64 (57%) were inappropriately discharged on a psychotropic agent. There was no statistically significant difference in mean ventilator days, hospital length of stay, intensive care unit length of stay, adjunctive benzodiazepine use, or discharge disposition. Patients with a psychiatric consult were more likely to be appropriately discharged (36 appropriate vs 7 inappropriate, p < 0.01).
Conclusions: There is a paucity of data looking at de-escalation techniques of psychotropic agents started in intensive care units and there are no specific guidelines available on de-escalating these agents started acutely in an intensive care unit. Patients inappropriately receiving psychotropic agents at discharge should have had the medication discontinued, a taper plan in place, or a follow-up appointment after discharge. The creation of a de-escalation guideline is warranted.