835: Impact of an Antipsychotic Discontinuation Bundle During Transitions of Care in Icu

Rincavage, Molly; Gonzales, Jeffrey; D’Angelo, Ryan G.; Flurie, Rachel; Tata, Asha; Millstein, Leah; Gulati, Mangla

doi:10.1097/01.ccm.0000509511.10594.04

Cited by 4 publications

(5 citation statements)

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“…Few studies have attempted to implement antipsychotic deprescribing interventions among critically ill patients at transitions of care. [23][24][25] These studies have had variable success in effectively and sustainably reducing the number of critically ill patients discharged from hospital with ongoing antipsychotic prescriptions by utilizing education, hand-off tools and algorithms, and pharmacist-driven prescriptive deprescribing authority as interventions. [23][24][25] This may be due to a lack of evidence-based rationale for implementation strategies addressing factors influencing healthcare professional behaviours.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] These studies have had variable success in effectively and sustainably reducing the number of critically ill patients discharged from hospital with ongoing antipsychotic prescriptions by utilizing education, hand-off tools and algorithms, and pharmacist-driven prescriptive deprescribing authority as interventions. [23][24][25] This may be due to a lack of evidence-based rationale for implementation strategies addressing factors influencing healthcare professional behaviours. The relevant domains from the TDF related to antipsychotic prescribing practices identified in our study provide an understanding of prescribing behaviours and what behaviours may need to be addressed to facilitate antipsychotic deprescribing.…”

Section: Discussionmentioning

confidence: 99%

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Facilitators and Barriers Influencing Antipsychotic Medication Prescribing and Deprescribing Practices in Critically Ill Adult Patients: a Qualitative Study

et al. 2023

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Background Antipsychotic medications do not alter the incidence or duration of delirium, but these medications are frequently prescribed and continued at transitions of care in critically ill patients when they may no longer be necessary or appropriate. Objective The purpose of this study was to identify and describe relevant domains and constructs that influence antipsychotic medication prescribing and deprescribing practices among physicians, nurses, and pharmacists that care for critically ill adult patients during and following critical illness. Design We conducted qualitative semi-structured interviews with critical care and ward healthcare professionals including physicians, nurses, and pharmacists to understand antipsychotic prescribing and deprescribing practices for critically ill adult patients during and following critical illness. Participants Twenty-one interviews were conducted with 11 physicians, five nurses, and five pharmacists from predominantly academic centres in Alberta, Canada, between July 6 and October 29, 2021. Main Measures We used deductive thematic analysis using the Theoretical Domains Framework (TDF) to identify and describe constructs within relevant domains. Key Results Seven TDF domains were identified as relevant from the analysis: Social/Professional role and identity; Beliefs about capabilities; Reinforcement; Motivations and goals; Memory, attention, and decision processes; Environmental context and resources; and Beliefs about consequences. Participants reported antipsychotic prescribing for multiple indications beyond delirium and agitation including patient and staff safety, sleep management, and environmental factors such as staff availability and workload. Participants identified potential antipsychotic deprescribing strategies to reduce ongoing antipsychotic medication prescriptions for critically ill patients including direct communication tools between prescribers at transitions of care. Conclusions Critical care and ward healthcare professionals report several factors influencing established antipsychotic medication prescribing practices. These factors aim to maintain patient and staff safety to facilitate the provision of care to patients with delirium and agitation limiting adherence to current guideline recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Facilitators and Barriers Influencing Antipsychotic Medication Prescribing and Deprescribing Practices in Critically Ill Adult Patients: a Qualitative Study

et al. 2023

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“…[14][15][16][17][18][19][20][21][22] Attempts to implement pharmacist-driven practices to reduce continuation at hospital discharge have been cumbersome and met with mixed success. [31][32][33][34] Kovacic and colleagues found that 41% of physicians assuming care of a patient transferring from the ICU did not know the indication for the psychoactive medication being continued. 20 Internal F I G U R E 3 Secondary analysis: target medication discontinued within 12 h of a transfer order out of the intensive care unit (ICU).…”

Section: Discussionmentioning

confidence: 99%

Impact of a computer‐assisted pharmacy transitions of care process on medication de‐prescribing when transferring from the intensive care unit

Nulph,

Bone,

Jacobs

et al. 2023

J Am Coll Clin Pharm

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IntroductionOur hospital instituted a computer‐generated intensive care unit (ICU) transitions of care task which prompts pharmacists to evaluate patients with orders to transfer out of the ICU and includes the scope of practice to de‐prescribe medications based upon set criteria.MethodsThis was a retrospective cohort analysis of adult patients transferred from the ICU to a lower level of care. The primary objective was to describe the number and type of interventions documented after implementation. The secondary objective was to compare, before and after implementation, the percent of inappropriate target medications discontinued within 12 h of ICU transfer order and continued upon hospital discharge.ResultsIn the 1‐year period after implementation, pharmacists identified interventions on 1290 of 3718 patients (34.7%) with transfer orders and documented a total of 1728 interventions. Data for 150 patients in each the pre‐implementation group and post‐implementation group were compared. Significantly more target acid suppressing medications and quetiapine were discontinued within 12 h of transfer order in the post‐ versus pre‐implementation group (famotidine 46% vs. 10%, p = 0.005; pantoprazole 80% vs. 5.5%, p < 0.001; quetiapine 71.4% vs. 10%, p = 0.005). Acid‐suppressing prescriptions started inpatient and continued at hospital discharge without indication were also reduced (famotidine 6.7% vs. 40%, p = 0.022; pantoprazole 6% vs. 41.1%, p < 0.001).ConclusionsImplementation of a pharmacist ICU transitions of care process was simple and resulted in pharmacist‐initiated medication reconciliation in one third of patients. The process significantly reduced the amount of inappropriate acid‐suppressing medications continued on ICU transfer and hospital discharge, as well as quetiapine continued on ICU transfer.

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“…85 Multidisciplinary bundles and physician-delegated pharmacist driven antipsychotic discontinuation policies have been effective at preventing inappropriate continuation of antipsychotics at hospital discharge. 86,87 Interest is renewed in the use of valproic acid for treatment of agitation and delirium in the ICU because of available its routes of administration and lack of association with QTc prolongation. Limited data are available for assessing valproate in the ICU.…”

Section: Single-component Interventions Have Been Unsuccessful At Imp...mentioning

confidence: 99%

Part II: Case series: Acute agitation, delirium, and sleep management

Smith

2024

J Am Coll Clin Pharm

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LEARNING OBJECTIVES1. Apply bedside clinical assessment tools to detect pain, agitation, and delirium in the critically ill patient.2. Design an evidence-based pharmacotherapy regimen for agitation in the critically ill patient.3. Evaluate pharmacologic approaches for prevention and management of ICU delirium.4. Assess therapeutic approaches to improve sleep quality in critically ill patients. 5. Develop a population-based approach for agitation, delirium, and sleep disturbance management in the ICU.

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835: Impact of an Antipsychotic Discontinuation Bundle During Transitions of Care in Icu

Cited by 4 publications

References 0 publications

Facilitators and Barriers Influencing Antipsychotic Medication Prescribing and Deprescribing Practices in Critically Ill Adult Patients: a Qualitative Study

Facilitators and Barriers Influencing Antipsychotic Medication Prescribing and Deprescribing Practices in Critically Ill Adult Patients: a Qualitative Study

Impact of a computer‐assisted pharmacy transitions of care process on medication de‐prescribing when transferring from the intensive care unit

Part II: Case series: Acute agitation, delirium, and sleep management

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