Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting.
OBJECTIVE
Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities.


METHODS
A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed.


RESULTS
Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis.


CONCLUSIONS
A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.
Tropea
J
J
Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia. Joanne.Tropea@mh.org.au
Slee
J
J
Holmes
A C N
AC
Gorelik
A
A
Brand
C A
CA
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003693:Delirium / Q000188:drug therapy* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data; D017050:Episode of Care; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data; D014739:Victoria
D014150:Antipsychotic Agents