A retrospective observational cohort study of prescribing and administration of psychotropic medications in elderly patients with delirium.

Abstract

Background: The utilization of chemical restraint in delirium is a major issue in the management of delirium. Psychotropic medications are not associated with reduced duration of delirium, length of hospital stay, or mortality. Understanding the trends of prescribing/administration of psychotropic medications in patients with delirium is imperative to inform guideline development, target specific interventions and assess quality of psychotropic medications use. Aim: In adult patients aged over 65 admitted to a general medical ward and coded for delirium, what are the trends in the prescribing and administration of psychotropic medications over time. Method: A retrospective observational cohort study was conducted in a regional public hospital in Australia. National Inpatient Medication Charts (NIMC) of eligible patients were reviewed throughout their admission. Data surrounding psychotropic medications (anti-psychotics, benzodiazepines, z-drugs) such as date, dose and administration records were recorded and run-charts were generated with descriptive analysis. Results: From July 2020 to July 2021, 64 admissions with 139 prescriptions and 362 administrations of psychotropic medications were analysed. The study showed that preferences of psychotropic medications were not aligned with guidelines utilised within the health service. Although overall, antipsychotics were prescribed/administered in preference to benzodiazepines and Z-drugs for delirium, there were two-time frames when greater number of benzodiazepines were administered compared to antipsychotics. Discussion: This study demonstrated partial adherence to the delirium guidelines with respect to the preferential use of antipsychotics. However, the preference of olanzapine over risperidone demonstrates further changes to prescribing and drug access are required. The use of run-charts allowed time based descriptive analysis, allowing for medical and nursing rotations to be reviewed with respect to prescribing and administration changes, with no clinically significant change seen. Data of the study will inform further practice change implementation and use as a comparator set following implementation of a delirium risk prevention program.