Antipsychotic prescription to identify delirium: results from two cohorts

Kristin M Zimmerman,1 Allison M Paquin,2 James L Rudolph3,4 1Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, 2Connecticut Center for Primary Care, ProHealth Physicians, Inc. Farmington, CT, USA; 3Research and Development Service, Center of Innovati...

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Autores principales:	Zimmerman KM, Paquin AM, Rudolph JL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Delirium antipsychotic aged palliative care quality improvement pharmacy practice Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/dd3f247e661746e8a43849a127982180
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spelling	oai:doaj.org-article:dd3f247e661746e8a43849a1279821802021-12-02T00:21:38ZAntipsychotic prescription to identify delirium: results from two cohorts1179-1438https://doaj.org/article/dd3f247e661746e8a43849a1279821802017-10-01T00:00:00Zhttps://www.dovepress.com/antipsychotic-prescription-to-identify-delirium-results-from-two-cohor-peer-reviewed-article-CPAAhttps://doaj.org/toc/1179-1438Kristin M Zimmerman,1 Allison M Paquin,2 James L Rudolph3,4 1Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, 2Connecticut Center for Primary Care, ProHealth Physicians, Inc. Farmington, CT, USA; 3Research and Development Service, Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, 4Warren Alpert Medical School and Brown School of Public Health, Brown University, Providence, RI, USA Objectives: Detection of delirium in hospitalized patients remains challenging. The objective was to determine if the prescription of antipsychotic medications was associated with delirium.Patients and methods: Two patient cohorts were utilized from a tertiary Veterans Affairs hospital: a palliative care retrospective cohort and a prospective medical cohort. Patients prescribed outpatient antipsychotics were excluded. Retrospectively, delirium was identified using a validated medical record-review instrument. Prospectively, a clinical expert assessed patients for delirium daily using a standardized interview. Acute antipsychotic medication administration was recorded from the electronic medical record.Results: In the retrospective cohort (n=217), delirium was found in 31% (n=67) and antipsychotic use in 18% (n=40) of patients. Acute antipsychotic use indicated delirium with 54% sensitivity and 97% specificity. In the prospective cohort (n=100), delirium developed in 23% (n=23) and antipsychotics were used in 5% (n=5) of patients. The sensitivity and specificity of acute antipsychotic use was 22% and 100%, respectively.Conclusion: Hospitalized patients who are acutely prescribed antipsychotics are likely to have delirium, but not all patients with delirium will be identified with this method. In health systems, utilization of the prescription of acute antipsychotics can be an efficient and specific method to identify delirious patients for targeted intervention. Keywords: delirium antipsychotic aged, palliative care, quality improvement, pharmacy practice Zimmerman KMPaquin AMRudolph JLDove Medical PressarticleDelirium antipsychotic agedpalliative carequality improvementpharmacy practiceTherapeutics. PharmacologyRM1-950ENClinical Pharmacology: Advances and Applications, Vol Volume 9, Pp 113-117 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Delirium antipsychotic aged palliative care quality improvement pharmacy practice Therapeutics. Pharmacology RM1-950
spellingShingle	Delirium antipsychotic aged palliative care quality improvement pharmacy practice Therapeutics. Pharmacology RM1-950 Zimmerman KM Paquin AM Rudolph JL Antipsychotic prescription to identify delirium: results from two cohorts
description	Kristin M Zimmerman,1 Allison M Paquin,2 James L Rudolph3,4 1Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, 2Connecticut Center for Primary Care, ProHealth Physicians, Inc. Farmington, CT, USA; 3Research and Development Service, Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, 4Warren Alpert Medical School and Brown School of Public Health, Brown University, Providence, RI, USA Objectives: Detection of delirium in hospitalized patients remains challenging. The objective was to determine if the prescription of antipsychotic medications was associated with delirium.Patients and methods: Two patient cohorts were utilized from a tertiary Veterans Affairs hospital: a palliative care retrospective cohort and a prospective medical cohort. Patients prescribed outpatient antipsychotics were excluded. Retrospectively, delirium was identified using a validated medical record-review instrument. Prospectively, a clinical expert assessed patients for delirium daily using a standardized interview. Acute antipsychotic medication administration was recorded from the electronic medical record.Results: In the retrospective cohort (n=217), delirium was found in 31% (n=67) and antipsychotic use in 18% (n=40) of patients. Acute antipsychotic use indicated delirium with 54% sensitivity and 97% specificity. In the prospective cohort (n=100), delirium developed in 23% (n=23) and antipsychotics were used in 5% (n=5) of patients. The sensitivity and specificity of acute antipsychotic use was 22% and 100%, respectively.Conclusion: Hospitalized patients who are acutely prescribed antipsychotics are likely to have delirium, but not all patients with delirium will be identified with this method. In health systems, utilization of the prescription of acute antipsychotics can be an efficient and specific method to identify delirious patients for targeted intervention. Keywords: delirium antipsychotic aged, palliative care, quality improvement, pharmacy practice
format	article
author	Zimmerman KM Paquin AM Rudolph JL
author_facet	Zimmerman KM Paquin AM Rudolph JL
author_sort	Zimmerman KM
title	Antipsychotic prescription to identify delirium: results from two cohorts
title_short	Antipsychotic prescription to identify delirium: results from two cohorts
title_full	Antipsychotic prescription to identify delirium: results from two cohorts
title_fullStr	Antipsychotic prescription to identify delirium: results from two cohorts
title_full_unstemmed	Antipsychotic prescription to identify delirium: results from two cohorts
title_sort	antipsychotic prescription to identify delirium: results from two cohorts
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/dd3f247e661746e8a43849a127982180
work_keys_str_mv	AT zimmermankm antipsychoticprescriptiontoidentifydeliriumresultsfromtwocohorts AT paquinam antipsychoticprescriptiontoidentifydeliriumresultsfromtwocohorts AT rudolphjl antipsychoticprescriptiontoidentifydeliriumresultsfromtwocohorts
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Antipsychotic prescription to identify delirium: results from two cohorts

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