Pharmacy residents have the opportunity to complete a research project during their residency training, which provides them with skills on how to conduct and manage a research project. Projects often represent an area of interest and need that has been recognized by the host institution’s pharmacy department. Projects are presented as a poster at an annual CSHP Ontario Branch Residency Research Night, and many eventually go on to be published in a peer-reviewed journal.Abstract
Introduction: To date, trials have only investigated short-term use of antipsychotics for ICU delirium. Observational studies show that among ICU patients who are newly initiated on antipsychotics, 47-84% have antipsychotics continued upon ICU transfer. Order sets may help standardize delirium management and ensure antipsychotic discontinuation upon delirium resolution.
Objective: To determine if an ICU delirium order set will decrease the proportion of patients continued on antipsychotics upon delirium resolution or ICU transfer.
Methods: A retrospective, single-centre, pre-post cohort study is being conducted. The pre-implementation cohort includes adult ICU patients started on scheduled antipsychotics within 48 hours of positive CAM-ICU screens between August 1, 2014 and November 30, 2015. For our interim analysis, the post-implementation cohort includes patients started on scheduled antipsychotics using the ICU delirium order set between February 22, 2016 and April 22, 2016 however, enrollment will continue until 50 patients are reached. The primary outcome is the proportion of patients continued on scheduled antipsychotics 24 hours after delirium resolution or ICU transfer.
Results: CAM-ICU screening was completed at least once per nursing shift 89% of the time in the pre-implementation cohort (n=26). In this cohort, antipsychotics were continued 24 hours after delirium resolution or ICU transfer in 12 patients. Among 15 patients with delirium resolution during their ICU admission, scheduled antipsychotics were continued in 10 patients. In the post-implementation cohort (n=3), 1 patient had delirium resolution during their ICU admission and was continued on antipsychotics beyond delirium resolution.
Conclusion: As this is an interim analysis, direct comparisons between the pre and post- implementation cohorts cannot be made. Delirium screening, a key aspect of delirium management, was completed routinely in the majority of patients in the pre-implementation cohort. In this cohort, a number of patients were continued on antipsychotics despite resolution of delirium
