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A Pharmacy-Based Electronic Handoff Tool to Reduce Discharge Prescribing of Atypical Antipsychotics Initiated in the Intensive Care Unit: A Quality Improvement Initiative.

Publication ,  Journal Article
Kram, BL; Schultheis, JM; Kram, SJ; Cox, CE
Published in: J Pharm Pract
August 2019

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.

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Published In

J Pharm Pract

DOI

EISSN

1531-1937

Publication Date

August 2019

Volume

32

Issue

4

Start / End Page

434 / 441

Location

United States

Related Subject Headings

  • Quality Improvement
  • Practice Patterns, Physicians'
  • Pharmacy Service, Hospital
  • Pharmacology & Pharmacy
  • Pharmacists
  • Patient Handoff
  • Patient Discharge
  • Middle Aged
  • Male
  • Intensive Care Units
 

Citation

APA
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ICMJE
MLA
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Kram, B. L., Schultheis, J. M., Kram, S. J., & Cox, C. E. (2019). A Pharmacy-Based Electronic Handoff Tool to Reduce Discharge Prescribing of Atypical Antipsychotics Initiated in the Intensive Care Unit: A Quality Improvement Initiative. J Pharm Pract, 32(4), 434–441. https://doi.org/10.1177/0897190018761412
Kram, Bridgette L., Jennifer M. Schultheis, Shawn J. Kram, and Christopher E. Cox. “A Pharmacy-Based Electronic Handoff Tool to Reduce Discharge Prescribing of Atypical Antipsychotics Initiated in the Intensive Care Unit: A Quality Improvement Initiative.J Pharm Pract 32, no. 4 (August 2019): 434–41. https://doi.org/10.1177/0897190018761412.
Kram, Bridgette L., et al. “A Pharmacy-Based Electronic Handoff Tool to Reduce Discharge Prescribing of Atypical Antipsychotics Initiated in the Intensive Care Unit: A Quality Improvement Initiative.J Pharm Pract, vol. 32, no. 4, Aug. 2019, pp. 434–41. Pubmed, doi:10.1177/0897190018761412.
Journal cover image

Published In

J Pharm Pract

DOI

EISSN

1531-1937

Publication Date

August 2019

Volume

32

Issue

4

Start / End Page

434 / 441

Location

United States

Related Subject Headings

  • Quality Improvement
  • Practice Patterns, Physicians'
  • Pharmacy Service, Hospital
  • Pharmacology & Pharmacy
  • Pharmacists
  • Patient Handoff
  • Patient Discharge
  • Middle Aged
  • Male
  • Intensive Care Units