1 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.
2 Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD, USA.
J Intensive Care Med. 2019 Jan;34(1):40-47. doi: 10.1177/0885066616686741. Epub 2017 Jan 4.
: Delirium affects a large proportion of patients admitted to the intensive care unit (ICU) and is associated with increased morbidity and mortality. Antipsychotics have become frequently used agents for the treatment of delirium; however, they are often continued at transitions of care. This has potential negative short- and long-term health consequences that are preventable. We investigated the antipsychotic tapering bundle's impact on the rate of antipsychotic continuation at transitions from the medical intensive care unit (MICU).
: This was a preretrospective and postretrospective chart review that included adult patients in the MICU initiated on antipsychotic therapy for ICU delirium. A bundled multidisciplinary education program and antipsychotic discontinuation algorithm were implemented in the MICU to provide recommendations for safe and effective use of antipsychotics for ICU delirium and minimize continuation of therapy at transitions of care. Rates of antipsychotic continuation at transition from the MICU were compared between the preintervention and postintervention groups with the χ test.
: A total of 140 patients in the prebundle group and 141 patients in the postbundle group were enrolled. Overall, baseline characteristics were similar. After implementation of the discontinuation bundle, antipsychotic continuation at MICU discharge decreased (27.9% in the prebundle group vs 17.7% in the postbundle group; P < .05). In the multivariate analysis, patients were less likely to be continued on antipsychotic therapy at MICU discharge after implementation of the bundle (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.26-0.86). There were also lower rates of overall antipsychotic continuation at hospital discharge (OR: 0.4; 95% CI: 0.18-0.89).
: This is the first study to demonstrate a reduction in antipsychotic continuation at transition from the MICU after implementation of an antipsychotic discontinuation bundle in ICU patients. We believe this bundle allows for safer transitions of care from the MICU and decreases unnecessary antipsychotic therapy.
谵妄影响了大量入住重症监护病房（ICU）的患者，并与发病率和死亡率的增加有关。抗精神病药已成为治疗谵妄的常用药物；然而，它们通常在护理过渡时继续使用。这可能会带来潜在的短期和长期健康负面影响，而这些影响是可以预防的。我们调查了抗精神病药逐渐减少方案对从内科重症监护病房（MICU）过渡时继续使用抗精神病药的比率的影响。
这是一项回顾性和回顾性图表审查，包括在内科 ICU 接受抗精神病药治疗 ICU 谵妄的成年患者。在 MICU 中实施了一个多学科教育计划和抗精神病药停药算法，为 ICU 谵妄的安全有效使用抗精神病药提供建议，并尽量减少治疗在护理过渡时的继续。通过 χ 检验比较了干预前组和干预后组在从 MICU 过渡时继续使用抗精神病药的比率。
共纳入了预捆绑组的 140 名患者和后捆绑组的 141 名患者。总体而言，基线特征相似。在停用方案实施后，MICU 出院时继续使用抗精神病药的情况减少（预捆绑组为 27.9%，后捆绑组为 17.7%；P <.05）。在多变量分析中，在实施方案后，患者在 MICU 出院时继续使用抗精神病药治疗的可能性降低（比值比 [OR]：0.47；95%置信区间 [CI]：0.26-0.86）。在医院出院时，总体上继续使用抗精神病药的比率也较低（OR：0.4；95% CI：0.18-0.89）。
这是第一项表明在 ICU 患者实施抗精神病药停药方案后，从 MICU 过渡时继续使用抗精神病药减少的研究。我们相信，该方案允许从 MICU 进行更安全的护理过渡，并减少不必要的抗精神病治疗。
