1108

Abstract

Introduction: Evaluate the appropriate use of anti-delirium medication in medical ICU patients while in the ICU, on discharge from the ICU and/or hospital. Hypothesis: Anti-delirium medications are continued inappropriately after resolution of delirium in the ICU and on ICU and/or hospital discharge. Methods: This is a retrospective cohort study including adult medical ICU patients who received at least two doses of typical/atypical antipsychotics and dexmedetomidine for ICU-delirium at Mount Sinai Hospital from February 2010 to August 2012. Results: Overall, 77 patients met the inclusion criteria. Mean age of patients was 57.8 (SD 15.2) years and mean length of ICU stay was 18.6 (SD 10.1) days. Hyperactive delirium was the most common indication for anti-delirium medication initiation and found in 75% of the patients. On ICU discharge, 39 patients (51%) were on anti-delirium medication and this was appropriate in 31 patients (79%). Twenty-six patients (67%) with anti-delirium medication continuation on ICU discharge were sent directly to long-term acute care facilities and use was appropriate in 22 (85%) of these patients. The most common anti-delirium medications on ICU discharge were quetiapine and olanzapine which were used in 22 patients (56%) and 8 patients (21%), respectively. On hospital discharge, 33 patients (43%) were on anti-delirium medication and this was appropriate in 26 patients (79%). Twenty-three patients (70%) with anti-delirium medication continuation on hospital discharge were sent to long-term acute care facilities and use was appropriate in 19 (83%) of these patients. The most common anti-delirium medications on hospital discharge were quetiapine and haloperidol which were used in 12 patients (36%) and 7 patients (21%), respectively. Conclusions: Though anti-delirium medications were continued after ICU and hospital discharge in many patients similar to results reported in previous studies, the use was found to be appropriate in most patients discharged from our institution. A multidisciplinary team effort which focuses on delirium daily contributed to this outcome. Anti-delirium medication use for delirium post ICU and/or hospital discharge to long-term acute care facilities needs further study.