Neuroleptics Inappropriately Continued Upon ICU Discharge

Neuroleptics are commonly used in critically ill patients to treat acute neurologic insults and intensive care unit (ICU) delirium, among other indications.

Although neuroleptic agents have proven to be effective for such acute processes, their prolonged use may be associated with an increased risk of adverse events such as drowsiness, arrhythmias, dystonic reactions, and mortality.

One recent study evaluated the disposition of neuroleptic agents initiated in ICU patients upon discharge.

The authors retrospectively reviewed the electronic medical records of 161 adults initiated on neuroleptics—including quetiapine, risperidone, olanzapine, trazodone, buspirone, and haloperidol—upon ICU admission. Patients admitted for trauma or surgery were more likely to be initiated on neuroleptics, with buspirone (42%) and quetiapine (38%) being the most common agents.

Those initiated on multiple neuroleptics in the ICU were more likely to be discharged from the ICU and hospital while remaining on neuroleptic agents, the researchers found. Furthermore, patients with a negative urine drug screen on admission or on trazodone were more likely to be discharged while still on neuroleptic agents.

Previous studies have shown that, in many instances, neuroleptics initiated in the ICU were continued upon discharge, with the majority of patients showing evidence of resolved delirium or no indication warranting further use of these agents. Additionally, continuing neuroleptic use post-discharge has been shown to result in higher pharmacy and health care costs.

Although this study had limited external validity, the authors concluded that specific patient populations were more susceptible to continued inappropriate use of neuroleptic agents. They identified a need for protocols to evaluate the appropriateness of continuing neuroleptic agents to avoid adverse events and unnecessary health care costs.

Transitions of care should not be a term that is focused on patients discharged from the hospital, regardless of disposition. This study brings awareness to inappropriate continuation of medications beginning in the ICU, or other specialized hospital units that typically downgrade patients and do not necessarily directly discharge them home.

Reference

Gilbert B, Morales JR, Searcy RJ, Johnson WD, Ferreira JA. Evaluation of neuroleptic utilization in the intensive care unit during transitions of care. Journal of Intensive Care Medicine. 10 Jan 2016.