Psychoactive medication use frequently continued beyond discharge

A pilot study of stewardship has found that the use of psychoactive medications (PMs) is commonly continued during transitions of care, often without knowledge of the initial indication.

“PMs are frequently administered in the intensive care unit (ICU) to provide comfort,” the investigators said. “Interventions focused on preventing their continuation after the acute phase of illness are needed.”

This single-centre, prospective, observational study sought to determine the frequency that patients with ICU-initiated PM were continued upon ICU and hospital discharge. Sixty consecutive adult ICU patients who received scheduled PM were included in the analysis.

The investigators then recorded the frequency of PM continued at ICU and hospital discharge. A pharmacist contacted the patient’s primary treatment team within 72 hours of ICU discharge to establish a rationale for continued use or to suggest treatment cessation.

Seventy-two percent of the 60 patients included continued using PM at ICU discharge, while 30 percent did so at hospital discharge. The pharmacist contacted 40 percent of treatment teams after ICU discharge, and this intervention led to PM discontinuation in half of the patients (50 percent).

Notably, the indication of 41 percent of patients’ PM after ICU discharge was either unknown by the non-ICU care team or incorrect. Medical ICU patients or those transferred to an outside facility were more likely to continue the use of PM at hospital discharge.

“Future studies should establish effective PM stewardship methods,” the investigators suggested.