Purpose Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient-and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs.

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.

OVID-19 was declared a pandemic by the World Health Organization (WHO) in March 2020, 1 and health care systems across the globe braced for a potentially large influx of patients with COVID-19 within hospitals. These situations played out in countries such as Italy, where health care systems quickly became overwhelmed. 2 In light of the impact of the pandemic on health care systems globally, many Canadian provinces reallocated health care resources to care for patients with COVID-19 by reducing surgical capacity. Consequently, a staggering number of nonurgent surgeries (surgeries for conditions not immediately threatening life or limb) 3 were delayed. For example, early in the COVID-19 pandemic response, Ontario delayed 185 000 surgeries, and the number of delayed surgeries during the fourth wave in Alberta climbed to more than 30 000 -a number that continues to increase at the time of writing (unpublished data, 2021). 1,4,5 The effect of delaying nonurgent surgeries in Canada has not been fully explored, but it is estimated that the backlog from just the first wave of COVID-19 in some provinces will take 84 weeks to clear. 5 Prepandemic evidence suggests that excessive surgical wait times can lead to poor physical health, increased anxiety, and decreased social interaction, ability to work and overall quality of life. 6,7 Factors that mediate the impact of delays in access to surgical care include patient choice in the delay, and the quality and quantity of communication from health care providers. 6,7 It is unclear whether these prepandemic factors (poor physical and mental health, and quality of life) are consistent with the effects of delaying surgery in the context of the