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- Title
A Pharmacy-Based Electronic Handoff Tool to Reduce Discharge Prescribing of Atypical Antipsychotics Initiated in the Intensive Care Unit: A Quality Improvement Initiative.
- Authors
Kram, Bridgette L.; Schultheis, Jennifer M.; Kram, Shawn J.; Cox, Christopher E.
- Abstract
Purpose: To evaluate whether a pharmacist-initiated electronic handoff tool can reduce the overall, and potentially inappropriate, hospital discharge prescribing rate of atypical antipsychotics (AAP) initiated in AAP-naive critically ill adults. Methods: This pre–post quality improvement study was initiated in 5 intensive care units (ICUs) at a large academic medical center. An electronic handoff tool (iVent) was utilized in the post-intervention period to enhance pharmacist communication at inpatient transitions of care. Results: Of the 358 included patients, the proportion of hospital survivors with an AAP initiated in the ICU receiving a hospital discharge prescription was not different between the pre- and post-intervention period (28.6% vs 22.2%, P =.12). The proportion of ICU survivors with an AAP continued at the time of ICU transfer to the floor was reduced post-intervention (78.7% vs 66.7%, P =.012). Additionally, the overall proportion of a patient's hospitalization receiving an AAP was also reduced (50.4% vs 42.8%, P =.008). A multivariate logistic regression demonstrated thatutilization of the electronic handoff tool was not associated with a reduction in hospital discharge prescribing of an AAP (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.57-1.65). Conclusions: A pharmacy-initiated electronic handoff tool may reduce the proportion of AAP-naive ICU survivors with an AAP continued at the time of ICU transfer. The handoff tool was not associated with a significant reduction in the discharge prescribing rates of AAPs for hospital survivors, but a clinically meaningful reduction was possibly achieved due to enhanced communication enabled by this tool.
- Subjects
ANTIPSYCHOTIC agents; ACADEMIC medical centers; COMMUNICATION; CONFIDENCE intervals; DRUGS; HOSPITAL care; INTENSIVE care units; MEDICAL care; MULTIVARIATE analysis; PHARMACISTS; QUALITY assurance; LOGISTIC regression analysis; DISCHARGE planning; CRITICALLY ill patient psychology; ELECTRONIC health records; ATTITUDES of medical personnel; INAPPROPRIATE prescribing (Medicine); ODDS ratio
- Publication
Journal of Pharmacy Practice, 2019, Vol 32, Issue 4, p434
- ISSN
0897-1900
- Publication type
Article
- DOI
10.1177/0897190018761412