Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
Alberta Health Services, Calgary, Alberta, Canada.
BMJ Open. 2022 Jun 29;12(6):e057585. doi: 10.1136/bmjopen-2021-057585.
Antipsychotic medications are commonly prescribed off-label in acutely ill patients for non-psychiatric clinical indications such as delirium or insomnia. New prescription initiation of antipsychotics in acute care settings increases the proportion of patients discharged home on antipsychotics without approved clinical indication. Long-term use of antipsychotics is associated with increased risk of sudden cardiac death, falls and cognitive impairment. An understanding of acute care off-label antipsychotic prescribing practices and healthcare professional, patient and family perceptions related to antipsychotic prescribing and deprescribing is necessary to facilitate in-hospital deprescribing initiatives.
We present the protocol for a scoping review following the methodology proposed by Arksey and O'Malley and the Scoping Review Methods Manual by the Joanna Briggs Institute. We will search five databases including MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science from inception to 3 July 2021 (ie, planned search date). We will include both peer-reviewed and non-peer-reviewed qualitative and quantitative studies to identify antipsychotic prescribing practices, and to describe healthcare professional, patient and family perceptions towards antipsychotic prescribing and deprescribing in the acute care setting. Protocols, systematic and scoping reviews will be excluded. Two reviewers will calibrate and perform study screening and data abstraction for quantitative and qualitative outcomes of eligible studies. Quantitative outcomes will include study identifiers, demographics and descriptive statistics of antipsychotic prescribing practices. Qualitative synthesis describing perceptions on antipsychotic prescribing practices will include deductive thematic analysis with mapping of themes to the domains of the Theoretical Domains Framework, a 14-domain behaviour and behaviour change framework.
No ethical approval will be required for this study as only data from published studies in which informed consent was obtained by primary investigators will be retrieved and analysed. The results of this scoping review will inform integrated knowledge translation initiatives aimed at in-hospital antipsychotic medication deprescribing.
抗精神病药物常用于为非精神科临床指征(如谵妄或失眠)治疗急性疾病患者,但这属于超说明书用药。在急性护理环境中,新开始使用抗精神病药物会增加未经批准的临床指征而出院的患者比例。长期使用抗精神病药物与增加心源性猝死、跌倒和认知障碍的风险相关。为了促进院内药物减量计划,了解急性护理中超说明书抗精神病药物的开具情况以及与抗精神病药物的开具和停药相关的医护人员、患者和家属的看法是必要的。
我们根据 Arksey 和 O'Malley 提出的方法以及 Joanna Briggs 研究所的 Scoping Review 方法手册提出了一个范围综述方案。我们将从五个数据库中进行搜索,包括 MEDLINE、EMBASE、CINAHL、PsycINFO 和 Web of Science,时间范围为从建库到 2021 年 7 月 3 日(即计划搜索日期)。我们将纳入同行评议和非同行评议的定性和定量研究,以确定抗精神病药物的开具情况,并描述急性护理环境中医护人员、患者和家属对抗精神病药物的开具和停药的看法。方案、系统综述和范围综述将被排除。两名审查员将对纳入研究的定量和定性结果进行校准和研究筛选及数据提取。定量结果将包括研究标识符、抗精神病药物开具情况的人口统计学和描述性统计。定性综合描述抗精神病药物开具情况的看法将包括对理论领域框架的主题进行演绎主题分析,并将主题映射到理论领域框架的 14 个领域。
这项研究不需要伦理批准,因为只会检索和分析已发表的研究数据,这些研究均已获得主要研究者的知情同意。这项范围综述的结果将为旨在进行院内抗精神病药物减量的综合知识转化计划提供信息。