SHM Converge Scientific Abstract ePoster Gallery-Antipsyschotic and Restraint Use in the Wake of the Covid-19 Pandemic

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This retrospective cross-sectional study examined trends in agitation management before and after the COVID-19 pandemic in a large tertiary academic hospital. The authors analyzed 133,906 adult admissions from August 2018 through January 2024, focusing on three measures: positive bCAM delirium screens, antipsychotic use, and mechanical restraint orders.<br /><br />The background highlights the clinical challenge of delirium-related agitation, which can lead to restraints for safety. Both antipsychotics and mechanical restraints carry important risks, including QT prolongation, extrapyramidal symptoms, respiratory depression, falls, thrombosis, rhabdomyolysis, and even death. The study aimed to assess whether the pandemic was associated with lasting changes in these practices.<br /><br />Results showed a marked increase in antipsychotic ordering over the past five years, along with a similar rise in antipsychotic administration. In contrast, bCAM positivity increased only mildly, possibly because delirium screening became more widespread across units. Mechanical restraint use rose briefly at the start of the pandemic but later returned to pre-pandemic levels. Importantly, the increase in antipsychotic use was more pronounced among bCAM-negative patients, suggesting that antipsychotics may be used increasingly in patients without documented delirium.<br /><br />In the full cohort, 39.8% of admissions had antipsychotics ordered, with higher rates among bCAM-positive patients (55.8%) than bCAM-negative patients (37.2%). In the pre-COVID non-ICU subset, 21.1% received antipsychotics, again more often among bCAM-positive patients.<br /><br />Overall, the study suggests that while restraint use normalized after the initial pandemic surge, antipsychotic use has continued to climb, especially among patients without delirium. The authors note that further research is underway to better understand unit-specific trends and drivers of this increase.

Asset Subtitle

George Book

Meta Tag

Author List Andrew Schreiner, Benjamin Kalivas, George Book, Jingwen Zhang, Justin Marsden, Marc Heincelman, Meghan K. Thomas

Category Research

Concept Antipsychotic Medication

Concept Mechanical Restraint

Concept bCAM

Concept Hospitalized Adult Patient

Concept Delirium

Distinguished Non-Finalist

Presenter Organization Medical University of South Carolina

Presenting Author George Book

Track Patient Safety

Keywords

agitation management

COVID-19 pandemic

delirium

bCAM screening

antipsychotic use

mechanical restraints

retrospective cross-sectional study

tertiary academic hospital

hospital admissions

patient safety

Antipsychotic Medication

Mechanical Restraint

bCAM

Hospitalized Adult Patient

Delirium