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1. A scoping review of perceptions from healthcare professionals on antipsychotic prescribing practices in acute care settings

Author

Natalia Jaworska, Stephana J. Moss, Karla D. Krewulak, Zara Stelfox, Daniel J. Niven, Zahinoor Ismail, Lisa D. Burry, and Kirsten M. Fiest

Subjects
Antipsychotic medications, Prescribing practices, Deprescribing, Acute care, Critical care, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Antipsychotic medications are frequently prescribed in acute care for clinical indications other than primary psychiatric disorders such as delirium. Unfortunately, they are commonly continued at hospital discharge and at follow-ups thereafter. The objective of this scoping review was to characterize antipsychotic medication prescribing practices, to describe healthcare professional perceptions on antipsychotic prescribing and deprescribing practices, and to report on antipsychotic deprescribing strategies within acute care. Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases from inception date to July 3, 2021 for published primary research studies reporting on antipsychotic medication prescribing and deprescribing practices, and perceptions on those practices within acute care. We included all study designs excluding protocols, editorials, opinion pieces, and systematic or scoping reviews. Two reviewers screened and abstracted data independently and in duplicate. The protocol was registered on Open Science Framework prior to data abstraction (10.17605/OSF.IO/W635Z). Results Of 4528 studies screened, we included 80 studies. Healthcare professionals across all acute care settings (intensive care, inpatient, emergency department) perceived prescribing haloperidol (n = 36/36, 100%) most frequently, while measured prescribing practices reported common quetiapine prescribing (n = 26/36, 76%). Indications for antipsychotic prescribing were delirium (n = 48/69, 70%) and agitation (n = 20/69, 29%). Quetiapine (n = 18/18, 100%) was most frequently prescribed at hospital discharge. Three studies reported in-hospital antipsychotic deprescribing strategies focused on pharmacist-driven deprescribing authority, handoff tools, and educational sessions. Conclusions Perceived antipsychotic prescribing practices differed from measured prescribing practices in acute care settings. Few in-hospital deprescribing strategies were described. Ongoing evaluation of antipsychotic deprescribing strategies are needed to evaluate their efficacy and risk.

Published
2022
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2. It Takes a Village…: Contending With Drug Shortages During Disasters

Author

Lisa D, Burry, Jeffrey F, Barletta, David, Williamson, Salmaan, Kanji, Ryan C, Maves, Jeffrey, Dichter, Michael D, Christian, James, Geiling, and Brian L, Erstad

Subjects
Internationality, Critical Care, Drug Industry, WHO, World Health Organization WHO, Strategic Stockpile, Antiviral Agents, Lopinavir, Article, Disasters, ICU, Intensive Care Unit, Humans, Hypnotics and Sedatives, IPF, International Pharmaceutical Federation, PPE, Personal protective equipment, LMIC, low- and middle-income countries, COVID-19, coronavirus disease, Inventories, Hospital, Ritonavir, United States Food and Drug Administration, Drug Repositioning, Surge Capacity, COVID-19, Length of Stay, Respiration, Artificial, FDA, Food and Drug Administration, United States, Drug Combinations, GMP, Good Manufacturing Practice, Pharmaceutical Preparations, NME, new molecular entities, Hydroxychloroquine
Abstract

Critical drug shortages have been widely documented during the coronavirus disease 2019 (COVID-19) pandemic, particularly for IV sedatives used to facilitate mechanical ventilation. Surges in volume of patients requiring mechanical ventilation coupled with prolonged ventilator days and the high sedative dosing requirements observed quickly led to the depletion of "just-in-time" inventories typically maintained by institutions. This manuscript describes drug shortages in the context of global, manufacturing, regional and institutional perspectives in times of a worldwide crisis such as a pandemic. We describe etiologic factors that lead to drug shortages including issues related to supply (eg, manufacturing difficulties, supply chain breakdowns) and variables that influence demand (eg, volatile prescribing practices, anecdotal or low-level data, hoarding). In addition, we describe methods to mitigate drug shortages as well as conservation strategies for sedatives, analgesics and neuromuscular blockers that could readily be applied at the bedside. The COVID-19 pandemic has accentuated the need for a coordinated, multi-pronged approach to optimize medication availability as individual or unilateral efforts are unlikely to be successful.

Published
2020

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