Introduction: In recent years, atypical antipsychotics, like, quetiapine, have gained traction for its off-label indications and sedative properties. The goal of this study is to describe the typical indication for quetiapine in the ICU and general medicine services to evaluate if quetiapine is being used according to evidence-based practice and guidelines. Methods: A retrospective analysis of an electronic medical record report was performed. Admitted patients who received a dose of quetiapine were included. General demographics collected include age, gender, and hospital length of stay. Additional data collected include quetiapine indication, CAM-ICU score at quetiapine initiation, duration of therapy, psych consult, home regimen, discharged on quetiapine, discharged from the ICU to the floor with a new quetiapine indication. Results: Over two months, 115 patients were identified and included. The cohort was ~63 years old, mostly male (60%), with an average hospital length of stay of 19 days. Delirium/agitation was the most frequent off-label indication (70%) with (30%) patients receiving quetiapine for a psychiatric or insomnia indication. At the initiation of quetiapine (38%) of patients were CAM positive. On average quetiapine was not initiated until six days into the hospital admission with (27%) of patients resuming a home regimen. During the admission (15%) of patients had a psychiatric consult placed. The cohort had (25%) of patients discharged from the ICU to the floor with quetiapine continued, and (44%) of patients discharged home with quetiapine that was a continuation of home therapy or a new start. The mortality rate for the entire population evaluated was 22%, additional comorbidities were not evaluated at the time of analysis. For delirium/agitation the common dosages were a combination of 25mg/25mg/50mg. For psychiatric indications the average dose was 100-300mg at bedtime. Conclusions: Psychoactive medications are frequently continued during transitions of care without a clear indication, especially in ICU patients discharging. To aid in discontinuation of potentially inappropriate use of atypical antipsychotics more effort should be made to prescribe according to true indication with a plan to discontinue when appropriate.