Continuation Rate of Atypical Antipsychotics After Discharge When Initiated in the Intensive Care Unit

Farrokh, Salia; Castle, Amber; Heavner, Mojdeh; Pisani, Margaret A.

doi:10.1177/0897190016645026

Cited by 20 publications

(29 citation statements)

References 26 publications

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“…This rate is consistent with current national trends as demonstrated by various studies which looked at such relationships. 13,17,19 Although a higher continuation rate in surgical ICUs has been described, 19 we did not find any difference between the subspecialty ICUs in which AAPs were initiated and their continuation following hospital discharge. We did however, find a high variability in prescribing practices of AAPs among the ICUs with the initiation rate as high as 50% in the surgical ICU.…”

Section: Discussioncontrasting

confidence: 50%

Continuation of atypical antipsychotic medications in critically ill patients discharged from the hospital: a single-center retrospective analysis

Karamchandani

Schoaps

Bonavia

et al. 2018

Therapeutic Advances in Drug Safety

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Background: Atypical antipsychotics (AAP) have been associated with reduced duration of delirium in the intensive care setting. However, long-term use of these drugs is associated with significant adverse events, including increased all-cause mortality in the elderly. Inappropriate continuation of AAPs after discharge from the intensive care unit (ICU) is worrisome and needs to be addressed. The aim of this work was to assess the prevalence of continuation of AAPs after hospital discharge and evaluate the associated risk factors. Method: This was a single-center retrospective chart analysis in the setting of adult ICUs at a tertiary care academic medical center. It involved all adult patients admitted to the ICU and initiated on AAPs from January 2012 to December 2014. The measurements were: (1) prevalence of ICU-initiated AAP continuation following hospital discharge, (2) risk factors associated with continuation of AAPs following hospital discharge, and (3) risk of continuation of AAPs in patients ⩾65 years of age. Results: A total of 55% of ICU patients initiated on AAPs were discharged from the hospital with a prescription for continued AAP therapy. Male sex and discharge location were highly associated with continuation upon discharge. Older patients (⩾65 years of age) were not at a higher risk of being continued on these drugs after discharge. Conclusion: Male sex and discharge to a healthcare facility were associated with a higher rate of continuation. Research into practical methods to reduce their continuation upon discharge should be performed to mitigate the long-term risks of AAP administration.

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Section: Discussioncontrasting

confidence: 50%

Continuation of atypical antipsychotic medications in critically ill patients discharged from the hospital: a single-center retrospective analysis

Karamchandani

Schoaps

Bonavia

et al. 2018

Therapeutic Advances in Drug Safety

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“…Other studies examining rates of discharge on antipsychotics started in the ICU found approximately 21-33% of patients were discharged home on an antipsychotic; whereas our results indicated 2.3-3.6% of patients had a new antipsychotic medication filled in 180 days after discharge. [3,33,36] This is further evidence of system-level…”

Section: Plos Onementioning

confidence: 55%

Statin discontinuation and new antipsychotic use after an acute hospital stay vary by hospital

Coe

Vincent²,

Iwashyna

2020

PLoS ONE

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Introduction Patients are at risk for medication problems after hospital admissions, particularly those with critical illness. Medication problems include continuation of acute medications and discontinuation of chronic medications after discharge. Little is known across a national integrated health care system about the extent of these two medication problems. Objective To examine the extent of statin medication discontinuation and new antipsychotic medication use after hospital discharge. Design Retrospective cohort study. Setting Veterans Affairs healthcare system.

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“…While there is an absence of strong evidence to support pharmacologic strategies to prevent or treat delirium, ICU providers need to provide treatment for agitated patients in order to maintain a safe environment. Based on studies of psychotic patients, but without any evidence in critically ill patients, ICU physicians often prescribe centrally acting, sedative drugs that have potential for adverse effects and a high rate of outpatient carryover (13).…”

Section: Commentarymentioning

confidence: 99%

Dexmedetomidine for hyperactive delirium: worth further study

Knauert

Pisani

2016

J. Thorac. Dis.

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Continuation Rate of Atypical Antipsychotics After Discharge When Initiated in the Intensive Care Unit

Abstract: Atypical antipsychotics initiated in the ICU are frequently continued after hospital discharge. Given the known risks associated with extended therapy, initiatives are needed to prevent inappropriate continuation.

Cited by 20 publications

References 26 publications

Continuation of atypical antipsychotic medications in critically ill patients discharged from the hospital: a single-center retrospective analysis

Continuation of atypical antipsychotic medications in critically ill patients discharged from the hospital: a single-center retrospective analysis

Statin discontinuation and new antipsychotic use after an acute hospital stay vary by hospital

Dexmedetomidine for hyperactive delirium: worth further study

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