title: Risk factors for discharge on a new antipsychotic medication after admission to an intensive care unit.
abstract: OBJECTIVE
  Increased awareness of delirium in the intensive care unit (ICU) has led to higher use of antipsychotic medications for treatment of delirium. These medications are often not discontinued at ICU or hospital discharge, which may increase the risk of inappropriate polypharmacy. Our study sought to identify risk factors for being discharged on a new antipsychotic medication after admission to a trauma-surgical ICU or neurocritical care unit.
  
  
  METHODS
  This was a retrospective cohort study at an academic medical center and included patients who were admitted to the trauma-surgical ICU or neurocritical care unit and received an antipsychotic medication. Those younger than 18 years, died before hospital discharge, or did not have complete documentation were excluded.
  
  
  RESULTS
  A total of 341 records were included in the final analysis. Of those, 82 (24%) were discharged on a new antipsychotic and 67% of those patients had no documented indication. Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.030 [95% confidence interval, 1.030-1.110]) and days treated with benzodiazepines (odds ratio, 1.101 [95% confidence interval, 1.060-1.143]) were independently associated with being discharged on a new antipsychotic medication.
  
  
  CONCLUSIONS
  Those patients with higher Acute Physiology and Chronic Health Evaluation II scores and more benzodiazepine days are at increased odds of being discharged on a new antipsychotic.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN.
authors.forename: A Shaun
authors.initials: AS
authors.lastname: Rowe
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN. Electronic address: lhamilt4@uthsc.edu.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hamilton
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Curtis
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN.
authors.forename: Camellia R
authors.initials: CR
authors.lastname: Davis
authors.affiliation: Methodist University Hospital, Memphis, TN.
authors.forename: Leslie N
authors.initials: LN
authors.lastname: Smith
authors.affiliation: Duke University Hospital, Durham, NC.
authors.forename: Grayson K
authors.initials: GK
authors.lastname: Peek
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN.
authors.forename: Victoria W
authors.initials: VW
authors.lastname: Reynolds
mesh_terms: D018806:APACHE; D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D003693:Delirium / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines
keywords: Antipsychotics; Benzodiazepines; Medication reconciliation; Opioids