Scientific Poster Session III - Residents and Fellows Research-in-Progress

Residents and Fellows Research in Progress
  Monday, October 14, 2024
  01:00 PM–02:30 PM

Abstract

Introduction: Antipsychotics are common pharmacotherapies for the acute management of agitation and delirium in hospitalized patients. These therapies are not indicated after delirium resolution in the absence of other psychiatric diagnoses. However, previously published literature suggests patients are being discharged on antipsychotics without appropriate indications. Antipsychotics are associated with many adverse events, associated with increased mortality in elderly patients with dementia, and increased readmission rates. Pharmacists can provide transitions of care services for patients and ensure antipsychotic therapies used for acute agitation/delirium are appropriately discontinued at discharge.

Research Question or Hypothesis: Hospitalized patients started on antipsychotics are discharged on them without a clear indication for long-term therapy.

Study Design: Retrospective, single-center, medication use evaluation

Methods: Patients 18 years or older prescribed oral antipsychotics (haloperidol, olanzapine, quetiapine, or risperidone) during hospital admission and were discharged with new prescriptions for these medications were included. The evaluation period was between July 1, 2022, and July 10, 2024. Patients were excluded if they were on an antipsychotic prior to admission. The primary outcome was the percentage of patients discharged on an antipsychotic with no clear indication for long-term use. Secondary outcomes included initiating service line, ICU length of stay, total hospital length of stay, and discharge disposition.

Results: A total of 50 patients were initiated and prescribed an oral antipsychotic at discharge. 76% (n = 38) of patients were started on therapy for agitation/delirium and were discharged on these medications without documentation of any other psychiatric indication. 61% (n = 23) of patients started on an antipsychotic for delirium/agitation were in the ICU, 34% (n = 13) were in the ED, and 5% (n = 2) in acute care.

Conclusion: A majority of patients initiated on an antipsychotic for agitation/delirium were discharged on therapy without documentation of another psychiatric indication. Quality improvement initiatives are needed to ensure these medications are appropriately discontinued on discharge.

Presenting Author

Alexander Kim PharmD
University of Michigan

Authors

Katie Ruf PharmD, MBA
UK HealthCare

Whitney Williams PharmD
UK HealthCare