Characterization of Nocturnal Neuroactive Medication Use and Related Sleep Documentation in Critically Ill Adults

Hamidi, Arzo; Roberts, Russel J.; Weinhouse, Gerald L.; Szumita, Paul M.; DeGrado, Jeremy; Dube, Kevin; Kovacevic, Mary P; Choi, Mia; Sevinsky, Regan; Duprey, Matthew; Devlin, John W.

doi:10.1097/cce.0000000000000367

Cited by 16 publications

(15 citation statements)

References 14 publications

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“…Pharmacists should regularly review the appropriateness of all neuroactive medications being administered at night to improve sleep and/or treat delirium. 35…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacists should regularly review the appropriateness of all neuroactive medications being administered at night to improve sleep and/or treat delirium. 35 Nighttime. Most efforts to improve ICU sleep occur at night and are focused on nonpharmacological interventions targeting specific modifiable risk factors for disrupted sleep.…”

Section: Bundle Componentsmentioning

confidence: 99%

“…2,54 Wider use and standardization of sleep documentation is also needed and can help spread awareness of sleep disturbances, bundle implementation, and interventions. 35,36 Many challenges exist surrounding sleep assessment in the ICU; feasible sleep assessment methods that are both valid and reliable are needed. 2,48 Inclusion of sleep in the ABCDEF bundle, a well-established interprofessional bundle shown to improve both ICU and post-ICU outcomes, should be considered as a strategy to better recognize disrupted sleep in the ICU and boost the use of sleep bundles to improve it.…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

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Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists

et al. 2021

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Objective: To review evidence for intensive care unit (ICU) sleep improvement bundle use, identify preferred sleep bundle components and implementation strategies, and highlight the role for pharmacists in developing and evaluating bundle efforts. Data Sources: Multiple databases were searched from January 1, 1990, to September 1, 2021, using the MeSH terms sleep, intensive care or critical care, protocol or bundle to identify comparative studies evaluating ICU sleep bundle implementation. Study Selection and Data Extraction: Study screening, data extraction, and risk-of-bias evaluation were conducted in tandem. The ICU quality improvement literature and Institute for Healthcare Improvement bundle improvement guidance were also reviewed to identify recommended strategies for successful sleep bundle use. Data Synthesis: Nine studies (3 randomized, 1 quasi-experimental, 5 before-and-after) were identified. Bundle elements varied and were primarily focused on nonpharmacological interventions designed to be performed during either the day or night; only 2 studies included a medication-based strategy. Five studies were associated with reduced delirium; 2 studies were associated with improved total sleep time and 2 with improved patient-perceived sleep. Pharmacists were involved directly in 4 studies. Relevance to Patient Care and Clinical Practice: Sleep improvement bundles are recommended for use in all critically ill adults; specific bundle elements and ICU team member roles should be individualized at the institution/ICU level. Pharmacists can help lead bundle development efforts and routinely deliver key elements. Conclusions: Pharmacists can play an important role in the development and implementation of ICU sleep bundles. Further research regarding the relative benefit of individual bundle elements on relevant patient outcomes is needed.

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“…Pharmacists should regularly review the appropriateness of all neuroactive medications being administered at night to improve sleep and/or treat delirium. 35…”

Section: Resultsmentioning

confidence: 99%

Section: Bundle Componentsmentioning

confidence: 99%

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

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Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists

et al. 2021

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“…Ultimately, there is lack of strong evidence for any pharmacological agent to promote sleep in the ICU. Yet, neuroactive medications are newly initiated in approximately 10% of critically ill patients admitted for greater than 24 h-most commonly melatonin agonists or antipsychotics-and continued for nearly three-quarters of nights that patients spend in the ICU [59]. This trend is concerning, especially because there is no pharmacological agent recommended by the PADAS guidelines to "promote sleep" [60,61].…”

Section: Pharmacological Strategiesmentioning

confidence: 99%

Optimizing Sleep and Circadian Health in the NeuroICU

LaBuzetta

Malhotra

Zee

et al. 2022

Curr Treat Options Neurol

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Purpose of Review This article introduces fundamental concepts in circadian biology and the neuroscience of sleep, reviews recent studies characterizing circadian rhythm and sleep disruption among critically ill patients and potentially links to functional outcomes, and draws upon existing literature to propose therapeutic strategies to mitigate those harms. Particular attention is given to patients with critical neurologic conditions and the unique environment of the neuro-intensive care unit. Recent Findings Circadian rhythm disruption is widespread among critically ill patients and sleep time is reduced and abnormally fragmented. There is a strong association between the degree of arousal suppression observed at the bedside and the extent of circadian disruption at the system (e.g., melatonin concentration rhythms) and cellular levels (e.g., core clock gene transcription rhythms). There is a paucity of electrographically normal sleep, and rest-activity rhythms are severely disturbed. Common care interventions such as

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“…Current guidelines recommend against routine antipsychotic use in this patient population (12). Antipsychotics are also increasingly being prescribed as sleep aids in critically ill patients (13), despite limited data to support this indication. Approximately one in three patients newly prescribed an antipsychotic medication in the ICU will be discharged from hospital with an ongoing prescription where the clinical indication for ongoing use is not clear (1, 14, 15).…”

mentioning

confidence: 99%

A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness

Jaworska

Makuk

Krewulak

et al. 2022

Critical Care Explorations

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OBJECTIVES: Antipsychotic medications are frequently prescribed to critically ill patients leading to their continuation at transitions of care thereafter. The aim of this study was to generate evidence-informed consensus statements with key stakeholders on antipsychotic minimization and deprescribing for ICU patients. DESIGN: We completed three rounds of surveys in a National modified Delphi consensus process. During rounds 1 and 2, participants used a 9-point Likert scale (1—strongly disagree, 9—strongly agree) to rate perceptions related to antipsychotic prescribing (i.e., experiences regarding delivery of patient care), knowledge and frequency of antipsychotic use, knowledge surrounding antipsychotic guideline recommendations, and strategies (i.e., interventions addressing current antipsychotic prescribing practices) for antipsychotic minimization and deprescribing. Consensus was defined as a median score of 1–3 or 7–9. During round 3, participants ranked statements on antipsychotic minimization and deprescribing strategies that achieved consensus (median score 7–9) using a weighted ranking scale (0–100 points) to determine priority. SETTING: Online surveys distributed across Canada. SUBJECTS: Fifty-seven stakeholders (physicians, nurses, pharmacists) who work with ICU patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Participants prioritized six consensus statements on strategies for consideration when developing and implementing interventions to guide antipsychotic minimization and deprescribing. Statements focused on limiting antipsychotic prescribing to patients: 1) with hyperactive delirium, 2) at risk to themselves, their family, and/or staff due to agitation, and 3) whose care and treatment are being impacted due to agitation or delirium, and prioritizing 4) communication among staff about antipsychotic effectiveness, 5) direct and efficient communication tools on antipsychotic deprescribing at transitions of care, and 6) medication reconciliation at transitions of care. CONCLUSIONS: We engaged diverse stakeholders to generate evidence-informed consensus statements regarding antipsychotic prescribing perceptions and practices that can be used to implement interventions to promote antipsychotic minimization and deprescribing strategies for ICU patients with and following critical illness.

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Characterization of Nocturnal Neuroactive Medication Use and Related Sleep Documentation in Critically Ill Adults

Cited by 16 publications

References 14 publications

Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists

Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists

Optimizing Sleep and Circadian Health in the NeuroICU

A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness

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