DON’T BE ATYPICAL – RETHINK QUETIAPINE: REDUCING QUETIAPINE FOR ICU DELIRIUM AT TRANSITIONS OF CARE

Stephanie Rennke, MD*1;Joanne Smith, PharmD2;Jane Mingjia Zhu, MD/MPP3;Kendall Gross, PharmD, BCPS, BCCCP1;Joyce Chang, MD1 and Ashley Thompson, PharmD, BCPS, BCCCP1, (1)University of California San Francisco Medical Center, San Francisco, CA, (2)Cleveland Clinic, Cleveland, OH, (3)University of Pennsylvania, Philadelphia, PA

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 121

Categories: Patient Safety, Research Abstracts

Keywords: ,

Background: Delirium is associated with increased duration of mechanical ventilation, longer intensive care unit (ICU) length of stay, increased mortality and cognitive impairment after discharge. Quetiapine has been associated with faster resolution but long-term use is associated with adverse effects. Patients are often discharged from the ICU and subsequently from the hospital on quetiapine without clear indications. Guidance is limited regarding discontinuation once delirium has resolved. The aim of this study is to evaluate if a multidisciplinary, multifaceted intervention reduced the proportion of patients discharged on quetiapine initiated for ICU delirium.

Methods: A single center, retrospective, observational, pre-post study included mixed adult ICU patients initiated on quetiapine for ICU delirium. Patients were excluded if they were prescribed quetiapine prior to admission, had an underlying psychiatric disorder or were actively withdrawing from alcohol. The bundled intervention included: 1) educational and awareness campaign and 2) a “quetiapine for ICU delirium” computerized physician order entry (CPOE) medication panel with an automatic medication discontinuation at 72 hours. The primary outcome was the proportion of patients prescribed quetiapine at hospital discharge pre- and post-intervention. Secondary outcomes included the proportion of patients transitioned out of the ICU on quetiapine, the total daily dose at each dose titration and the Confusion Assessment Method for the ICU (CAM-ICU) status at each dose titration. Data were analyzed using chi-square or Fisher Exact test, where appropriate.

Results: Baseline characteristics were similar between pre (n=66) and post-intervention (n=27) groups. The primary outcome was significantly reduced following intervention (pre 22.7% vs post 3.7%, p=0.033). There was no difference in the proportion of patients discharged from the ICU to the floor on quetiapine (pre 44.0% versus post 25.9%; p=0.15) or the proportion of patients who were CAM-ICU negative upon quetiapine initiation (pre 35.4% versus post 29.6%, p=0.25). The delirium order panel was used in 16 (59.3%) patients post-intervention. The total daily quetiapine dose was less than 50 mg for the majority of dose titrations in both groups.

Conclusions: A bundled intervention reduced the proportion of patients discharged on quetiapine initiated for ICU delirium and represents a novel means of reducing inappropriate medication use at transitions of care.

To cite this abstract:

Rennke, S; Smith, J; Zhu, JM; Gross, K; Chang, J; Thompson, A . DON’T BE ATYPICAL – RETHINK QUETIAPINE: REDUCING QUETIAPINE FOR ICU DELIRIUM AT TRANSITIONS OF CARE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 121. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/dont-be-atypical-rethink-quetiapine-reducing-quetiapine-for-icu-delirium-at-transitions-of-care/. Accessed July 22, 2019.

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