Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge.

Abstract

IntroductionDelirium is an acute, fluctuating change in mental status, often associated with behavioral manifestations such as agitation. Literature suggests that many patients who continue on antipsychotics for extended management of delirium are not provided instructions for discontinuation. However, there is a positive correlation between consult services and instructions for discontinuation. The objective of this study was to determine the frequency at which patients with delirium were prescribed an antipsychotic at hospital discharge and to characterize discharge antipsychotic prescribing for psychiatric consult and nonconsult cohorts.MethodsThis study was a retrospective chart review of adult patients with an International Classification of Diseases 10th revision code of delirium who received at least 1 dose of antipsychotic during their admission. Inclusion criteria were all patients aged 18 years or older with a diagnosis of or relating to delirium who were administered antipsychotics during their admission.ResultsA total of 152 patients were included, of which 43 received a psychiatric consult. Antipsychotics were prescribed at discharge for management of delirium for 52 (34.2%) of 152 total patients. More patients in the psychiatric consult cohort were discharged with an antipsychotic as compared to those in the nonconsult cohort (53.3% vs 26.6%, P = .02).DiscussionCompared to previous studies, patients in this retrospective review were more likely to be discharged on an antipsychotic that was initiated during admission for management of delirium. Findings from this study also align with prior research demonstrating a positive association between antipsychotic discharge instructions and specialty consult recommendations.