Evaluation of Neuroleptic Utilization in the Intensive Care Unit During Transitions of Care

Gilbert, Brian W.; Morales, James; Searcy, Randi; Johnson, Donald W.; Ferreira, Jason

doi:10.1177/0885066615622424

Cited by 9 publications

(20 citation statements)

References 11 publications

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“…Reported risk factors for hospital discharge with ICU-initiated antipsychotics are severity of illness, duration of antipsychotic therapy, type and number of antipsychotics used, duration of benzodiazepine sedative treatment and hospital discharge location [6,9,10,16,17].…”

Section: Introductionmentioning

confidence: 99%

Discharge from hospital with newly administered antipsychotics after intensive care unit delirium – Incidence and contributing factors

Lambert

Vermassen

Fierens

et al. 2021

Journal of Critical Care

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Section: Introductionmentioning

confidence: 99%

Discharge from hospital with newly administered antipsychotics after intensive care unit delirium – Incidence and contributing factors

Lambert

Vermassen

Fierens

et al. 2021

Journal of Critical Care

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“… 5 Furthermore, the most common drug interactions leading to QTc prolongation, haloperidol, was among the first five frequently prescribed drugs in patients. 3 …”

Section: Antipsychoticsmentioning

confidence: 99%

“… 2 According to Gilbert et al study, agitation and delirium occur in 60% and 80% of patients in the ICU, respectively, and there is a direct relationship between the incidence of these complications with mortality rate, duration of mechanical ventilation, and medical costs. 3 …”

Section: Introductionmentioning

confidence: 99%

“…The need for appropriate sedative drugs in these patients as well as managing multiple psychiatric disturbances, including insomnia, pain, agitation, and delirium have caused unavoidable administration of a wide range of psychotropic agents in this ward. 3 Treating agitation and delirium even gets more difficult in patients with drug abuse who develop withdrawal symptoms on abstinence from the drug. 4 At the same time, psychotropic drugs should be carefully selected, since patients are at high risk of adverse drug–drug interactions.…”

Section: Introductionmentioning

confidence: 99%

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Psychotropic drug therapy in patients in the intensive care unit - usage, adverse effects and drug interactions: a review

Shafiekhani

Mirjalili

2018

TCRM

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Managing psychological problems in patients admitted to intensive care unit (ICU) is a big challenge, requiring pharmacological interventions. On the other hand, these patients are more prone to side effects and drug interactions associated with psychotropic drugs use. Benzodiazepines (BZDs), antidepressants, and antipsychotics are commonly used in critically ill patients. Therefore, their therapeutic effects and adverse events are discussed in this study. Different studies have shown that non-BZD drugs are preferred to BZDs for agitation and pain management, but antipsychotic agents are not recommended. Also, it is better not to start antidepressants until the patient has fully recovered. However, further investigations are required for the use of psychotropic drugs in ICUs.

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“…Unfortunately, when the patient improves, the restart of this medication is easily forgotten. In addition, medication initiated during the ICU stay for short-term use, such as gastric acid secretion inhibitors [ 6 – 8 ] and antipsychotics [ 9 – 13 ], is often inadvertently continued after ICU and even after hospital discharge [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design

Bosma

Hunfeld

Quax

et al. 2018

Ann. Intensive Care

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BackgroundMedication errors occur frequently in the intensive care unit (ICU) and during care transitions. Chronic medication is often temporarily stopped at the ICU. Unfortunately, when the patient improves, the restart of this medication is easily forgotten. Moreover, temporal ICU medication is often unintentionally continued after ICU discharge. Medication reconciliation could be useful to prevent such errors. Therefore, the aim of this study was to determine the effect of medication reconciliation at the ICU.MethodsThis prospective 8-month study with a pre- and post-design was carried out in two ICU settings in the Netherlands. Patients were included when they used ≥ 1 chronic medicine and when the ICU stay exceeded 24 h. The intervention consisted of medication reconciliation by pharmacists at the moment of ICU admission and prior to ICU discharge. Medication transfer errors (MTEs) were collected and the severity of potential harm of these MTEs was measured, based on a potential adverse drug event score (pADE = 0; 0.01; 0.1; 0.4; 0.6). Primary outcome measures were the proportions of patients with ≥ 1 MTE at ICU admission and after discharge. Secondary outcome measures were the proportions of patients with a pADE score ≥ 0.01 due to these MTEs, the severity of the pADEs and the associated costs. Odds ratio and 95% confidence intervals were calculated, by using a multivariate logistic regression analysis.ResultsIn the pre-intervention phase, 266 patients were included and 212 in the post-intervention phase. The proportion of patients with ≥ 1 MTE at ICU admission was reduced from 45.1 to 14.6% (ORadj 0.18 [95% CI 0.11–0.30]) and after discharge from 73.9 to 41.2% (ORadj 0.24 [95% CI 0.15–0.37]). The proportion of patients with a pADE ≥ 0.01 at ICU admission was reduced from 34.8 to 8.0% (ORadj 0.13 [95% CI 0.07–0.24]) and after discharge from 69.5 to 36.2% (ORadj 0.26 [95% CI 0.17–0.40]). The pADE reduction resulted in a potential net cost–benefit of € 103 per patient.ConclusionsMedication reconciliation by pharmacists at ICU transfers is an effective safety intervention, leading to a significant decrease in the number of MTE and a cost-effective reduction in potential harm.Trial registration Dutch trial register: NTR4159, 5 September 2013, retrospectively registered

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Evaluation of Neuroleptic Utilization in the Intensive Care Unit During Transitions of Care

Abstract: Risk factors associated with the continuation of inappropriate neuroleptic medications upon discharge from the ICU or the hospital include multiple neuroleptic medications prescribed, the lack of a urine drug screen upon admission, and the utilization of trazodone.

Cited by 9 publications

References 11 publications

Discharge from hospital with newly administered antipsychotics after intensive care unit delirium – Incidence and contributing factors

Discharge from hospital with newly administered antipsychotics after intensive care unit delirium – Incidence and contributing factors

Psychotropic drug therapy in patients in the intensive care unit - usage, adverse effects and drug interactions: a review

The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design

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