- Design
- Retrospective cohort using US insurance claims
- Population
- 7,898 adults after ICU admission with invasive ventilation, no prior psychoactive use
- Primary outcome
- New psychoactive prescriptions without documented supporting diagnosis within 30 days
- Effect
- 207 of 484 prescriptions (42.8%) unsupported; antipsychotics 52.4%
This US claims study followed 7,898 adults discharged after ICU admission with invasive ventilation in 2018 and 2019, none of whom had been taking psychoactive medicines beforehand.
In the 30 days after discharge, 416 (5.3%) were newly prescribed 484 psychoactive medicines: anxiolytics, antidepressants, antipsychotics and sleep aids. Of these, 42.8% had no documented diagnosis to support them, including 52.4% of antipsychotics and 45.6% of anxiolytics. Unsupported prescribing persisted over the following two years.
The likely source is medication started for delirium, agitation or sleep in intensive care and carried through discharge without a plan. Not every undocumented prescription is wrong, but these are drugs with real harms, and the gap is where reconciliation at step-down and discharge should focus.
- Review every antipsychotic and sedative started in intensive care before step-down.
- Record the indication and a stop date for any psychoactive drug continued at discharge.
- Flag new psychoactive prescriptions in discharge letters so the GP can review them.
- Assess for post-intensive care anxiety, depression and PTSD rather than continuing drugs by default.
Why it matters
Drugs started for ICU delirium can become long-term prescriptions nobody chose.
Don't overread it
Claims data cannot show which prescriptions were inappropriate, only which lacked a coded reason.
The statistics, in plain English
The 42.8% figure depends on diagnosis codes in claims data; some prescriptions may have had a reason that was not coded. The direction of the finding is clear even if the exact proportion is uncertain.
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