TY - JOUR
T1 - Characterization of Nocturnal Neuroactive Medication Use and Related Sleep Documentation in Critically Ill Adults
AU - Hamidi, Arzo
AU - Roberts, Russel J.
AU - Weinhouse, Gerald L.
AU - Szumita, Paul M.
AU - Degrado, Jeremy R.
AU - Dube, Kevin M.
AU - Kovacevic, Mary P.
AU - Choi, Mia
AU - Sevinsky, Regan
AU - Duprey, Matthew S.
AU - Devlin, John W.
N1 - Publisher Copyright:
© 2021 Critical Care Explorations. All rights reserved.
PY - 2021/3/15
Y1 - 2021/3/15
N2 - We retrospectively characterized scheduled, newly initiated, nocturnal neuroactive medication use, and related clinician documentation, in a cohort of consecutive adults admitted greater than or equal to 24 hours to seven different medical/surgical ICUs at two academic centers who had not received a scheduled nocturnal neuroactive medication prior to admission, over a 5-month period (April 1, 2017, to August 31, 2017). A total of 207 different newly initiated, scheduled nocturnal neuroactive medication orders were written (melatonin agonist 101 [48.8%], antipsychotic 80 [38.6%], antidepressant 17 [8.2%], benzodiazepine 9 [4.3%]) in 189 (9.7%) of the 1,955 patients. Among the 1,553 nights, the 189 patients spent in the ICU, a scheduled nocturnal neuroactive medication was administered on 1,103 (71%), an "as needed" nocturnal neuroactive medication was solely administered on 183 (11.8%), delirium occurred on 736 (47.4%), and nurses were twice as likely as physicians (28.8% vs 11.4%; p < 0.0001) to document a note about sleep quality. Among the 69.8% of patients discharged to the floor, and the 64.5% from the hospital, the scheduled nocturnal neuroactive medication was continued in 85.6% and 87.3%, respectively. Scheduled nocturnal neuroactive medication initiation is common, often continued beyond hospital discharge, and poorly documented.
AB - We retrospectively characterized scheduled, newly initiated, nocturnal neuroactive medication use, and related clinician documentation, in a cohort of consecutive adults admitted greater than or equal to 24 hours to seven different medical/surgical ICUs at two academic centers who had not received a scheduled nocturnal neuroactive medication prior to admission, over a 5-month period (April 1, 2017, to August 31, 2017). A total of 207 different newly initiated, scheduled nocturnal neuroactive medication orders were written (melatonin agonist 101 [48.8%], antipsychotic 80 [38.6%], antidepressant 17 [8.2%], benzodiazepine 9 [4.3%]) in 189 (9.7%) of the 1,955 patients. Among the 1,553 nights, the 189 patients spent in the ICU, a scheduled nocturnal neuroactive medication was administered on 1,103 (71%), an "as needed" nocturnal neuroactive medication was solely administered on 183 (11.8%), delirium occurred on 736 (47.4%), and nurses were twice as likely as physicians (28.8% vs 11.4%; p < 0.0001) to document a note about sleep quality. Among the 69.8% of patients discharged to the floor, and the 64.5% from the hospital, the scheduled nocturnal neuroactive medication was continued in 85.6% and 87.3%, respectively. Scheduled nocturnal neuroactive medication initiation is common, often continued beyond hospital discharge, and poorly documented.
KW - antipsychotics
KW - delirium
KW - intensive care
KW - melatonin
KW - ramelteon
KW - sleep
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U2 - 10.1097/CCE.0000000000000367
DO - 10.1097/CCE.0000000000000367
M3 - Article
AN - SCOPUS:85113174107
SN - 2639-8028
VL - 3
SP - E0367
JO - Critical Care Explorations
JF - Critical Care Explorations
IS - 3
ER -