Discharge Plans for Geriatric Inpatients with Delirium: A Plan to Stop Antipsychotics?

Johnson, Kurt E.; Fashoyin, Adedayo; Madden‐Fuentes, Ramiro J.; Muzyk, Andrew J.; Gagliardi, Jane P.; Yanamadala, Mamata

doi:10.1111/jgs.15026

Cited by 20 publications

(22 citation statements)

References 21 publications

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“…Approximately one third of patients in this study were discharged on an antipsychotic. Other findings from this study align with prior research 9 in that there was a positive association between antipsychotic discharge instructions for continuation or discontinuation and specialty consult recommendations.…”

Section: Discussionsupporting

confidence: 88%

“…Compared to previous studies, 5,9 patients included in this retrospective review were more likely to be discharged on an antipsychotic that was initiated during admission for management of delirium. Approximately one third of patients in this study were discharged on an antipsychotic.…”

Section: Discussionmentioning

confidence: 99%

“…7 Likewise, Fontaine et al 8 reported that of 8297 patients without an identified psychiatric illness besides delirium, 334 were prescribed a discharge antipsychotic. Furthermore, Johnson et al 9 found that of 487 elderly medical and surgical patients initiated on a new antipsychotic, 147 were discharged on an antipsychotic, with delirium being the most common indication (n ¼ 121). The majority of patients (n ¼ 106) discharged on an antipsychotic for delirium did not receive instructions for discontinuation or further follow-up after discharge.…”

Section: Introductionmentioning

confidence: 99%

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Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge

Halavonich¹,

Robert²,

McGraw³

et al. 2020

Mental Health Clinician

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Introduction Delirium is an acute, fluctuating change in mental status, often associated with behavioral manifestations such as agitation. Literature suggests that many patients who continue on antipsychotics for extended management of delirium are not provided instructions for discontinuation. However, there is a positive correlation between consult services and instructions for discontinuation. The objective of this study was to determine the frequency at which patients with delirium were prescribed an antipsychotic at hospital discharge and to characterize discharge antipsychotic prescribing for psychiatric consult and nonconsult cohorts. Methods This study was a retrospective chart review of adult patients with an International Classification of Diseases 10th revision code of delirium who received at least 1 dose of antipsychotic during their admission. Inclusion criteria were all patients aged 18 years or older with a diagnosis of or relating to delirium who were administered antipsychotics during their admission. Results A total of 152 patients were included, of which 43 received a psychiatric consult. Antipsychotics were prescribed at discharge for management of delirium for 52 (34.2%) of 152 total patients. More patients in the psychiatric consult cohort were discharged with an antipsychotic as compared to those in the nonconsult cohort (53.3% vs 26.6%, P = .02). Discussion Compared to previous studies, patients in this retrospective review were more likely to be discharged on an antipsychotic that was initiated during admission for management of delirium. Findings from this study also align with prior research demonstrating a positive association between antipsychotic discharge instructions and specialty consult recommendations.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge

Halavonich¹,

Robert²,

McGraw³

et al. 2020

Mental Health Clinician

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“…28 In addition, a systematic review and metaanalysis of 19 studies found no benefi t of antipsychotic medications for preventing or treating delirium in hospitalized adults. 29 Antipsychotics are often continued indefi nitely A retrospective chart review at a US academic health system found 30 that among 487 patients with a new antipsychotic medication prescribed during hospitalization, 147 (30.2%) were discharged on an antipsychotic. Of these, 121 (82.3%) had a diagnosis of delirium.…”

Section: Antipsychotics May Worsen Deliriummentioning

confidence: 99%

Geriatrics update 2018: Challenges in mental health, mobility, and postdischarge care

Kim

Hashmi

2018

CCJM

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Nonpharmacologic interventions Home occupational therapy. A 2-year homebased occupational therapy intervention 1 showed no evidence of slowing functional decline in patients with Alzheimer disease. The randomized controlled trial involving 180 participants consisted of monthly sessions of an intensive, well-established collaborative-care management model that included fall prevention and other safety strategies, personalized training in activities of daily living, exercise, and education. Outcome measures for activi

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“…Antipsychotics have been identi ed as being overused and having limited clinical bene t for BPSD [6,7] and should not be continued for more than three months [8]. Consequently, the risk for PWD remains high if these medications are not discontinued at discharge [9]. The prevalence of PIMs for PWD in the community has been reported in a systematic review, to range from 10-56% and is higher in nursing home settings [5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Effect of an Intervention on Potentially Inappropriate Medications (PIMS), Polypharmacy and Anticholinergic Burden Scores for People with Dementia; Results from the SMS Dementia Study†: A Quasi-Experimental Study

Kable¹,

Fraser

Fullerton

et al. 2020

Preprint

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Background People with dementia (PWD) are at risk for medication related harm due to their impaired cognition and frequently being prescribed many medications. Few previous studies of PWD inpatients have been focused on medication safety interventions.This study aimed to evaluate an intervention designed to improve medication safety for people with dementia (PWD) and their carers during an unplanned admission to hospital. This article reports the effect of the intervention on potentially inappropriate medications (PIMs), polypharmacy and anticholinergic burden scores for PWD in the study. Methods A quasi-experimental pre-post design using an intervention site and a control site was conducted in 2017-2019, in a regional area in New South Wales, Australia. PIMs, polypharmacy and anticholinergic burden were measured at admission, discharge and three months after discharge. In addition, medication reconciliation at admission and scoring of pharmacists recommendations using severity and relevance scores were measured. Results There were 628 participants including 350 in the post-intervention phase. Polypharmacy for these admissions was high, and there was approximately 30% reduction in the number of medications at discharge. PIMs at admission were also high, and decreased significantly at discharge however there was no treatment effect associated with the intervention. The mean anticholinergic burden score also decreased significantly between admission and discharge, however, no treatment effect was seen. Conclusions High rates of polypharmacy and PIMs in this study indicate this study population was admitted with multiple comorbidities. Reduced PIMs at discharge were correlated with reduced anticholinergic burden. Medication reconciliation resulted in many recommendations that contributed to the reductions in medications. Although the study did not report a treatment effect, reductions in the number of medications and PIMs reduced medication related risk for PWD. Reduced risks associated with inappropriate or unnecessary medications can reduce hospital admissions and adverse events for PWD. This intervention was feasible to implement, and future multisite studies should be designed to recruit larger study samples to evaluate interventions for improving medication safety for PWD. They should also adopt routine screening for cognitive impairment to identify PWD at admission.

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Discharge Plans for Geriatric Inpatients with Delirium: A Plan to Stop Antipsychotics?

Abstract: In our health system, the majority of geriatric patients with delirium, discharged on a new antipsychotic had no instructions outlined to outpatient providers for discontinuation management. Further interventions could target increasing antipsychotic guidance at transitions of care.

Cited by 20 publications

References 21 publications

Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge

Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge

Geriatrics update 2018: Challenges in mental health, mobility, and postdischarge care

Evaluation of the Effect of an Intervention on Potentially Inappropriate Medications (PIMS), Polypharmacy and Anticholinergic Burden Scores for People with Dementia; Results from the SMS Dementia Study†: A Quasi-Experimental Study

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