DepRescribing PsychoActive MedicATions in the ICU (DRAMATIC): A Retrospective Chart Review
CCCF ePoster library. Eisa M. Nov 7, 2018; 233413; 12
Monique Eisa
Monique Eisa
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Background: Psychoactive medications, such as antipsychotics, benzodiazepines, and non-benzodiazepine sedatives, are frequently initiated in the intensive care unit (ICU) to manage sedation, agitation, and delirium. Initiation of these drugs in the ICU is meant only for short term symptom control. However, without a formalized deprescribing process, these newly initiated psychoactive medications may be continued beyond the ICU. Small medication reconciliation studies showed 26-84% of ICU patients initiated on antipsychotic therapy continued after ICU discharge and 10-34% after hospital discharge.1-7 A cohort study of patients hospitalized in Ontario between 2003 and 2011 found that 1.4% of patients continued an antipsychotic on hospital discharge without documented indication and 3.3% continued a benzodiazepine.8

Objectives: To determine the proportion of ICU patients continued on a new psychoactive drug at ICU discharge and subsequent hospital discharge.

Methods: We conducted a multicenter, retrospective chart review of ICU patients admitted between April 2016 and April 2017. We included all patients except those deemed palliative on ICU admission. Data was extracted from medical charts (e.g. patient demographics, medication history, ICU and hospital drug exposure). Descriptive statistics were performed according to data distribution.

Results: Preliminary results are available from one center. We screened the first 5 weeks of consecutive charts in the study period. A total of 100 patients (mean age 56 ± 18 years; 45% male; mean SOFA score 5 ± 4) were included; 4 were excluded due to palliative status. We found 32 patients (32%) had a new psychoactive drug initiated in ICU: antipsychotic (n = 17), benzodiazepine (n = 21), non-benzodiazepine sedative (n = 5). Of these 32 patients, 13 (41%) had the new psychoactive drug(s) continued at ICU discharge and 4 (13%) had the drug(s) continued at hospital discharge. The psychoactive medications most frequently continued at ICU discharge were antipsychotics (n =7) and benzodiazepines (n = 6). One patient did not have a documented indication for a new drug at hospital discharge.

Conclusion: Preliminary results suggest that approximately 40% of patients that received a new psychoactive drug during ICU admission have the drug continued on ICU discharge. Yet, few of these patients are discharged from hospital on a new psychoactive drug. We will examine the remaining admissions during the study period to confirm these findings. Data from a second center with a different ICU population will also be analyzed to increase generalizability of results.

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