Characterization of Nocturnal Neuroactive Medication Use and Related Sleep Documentation in Critically Ill Adults

Arzo Hamidi, Russel J. Roberts, Gerald L. Weinhouse, Paul M. Szumita, Jeremy R. Degrado, Kevin M. Dube, Mary P. Kovacevic, Mia Choi, Regan Sevinsky, Matthew S. Duprey, John W. Devlin

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)E0367
JournalCritical Care Explorations
Volume3
Issue number3
DOIs
StatePublished - Mar 15 2021

Bibliographical note

Publisher Copyright:
© 2021 Critical Care Explorations. All rights reserved.

Keywords

  • antipsychotics
  • delirium
  • intensive care
  • melatonin
  • ramelteon
  • sleep

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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