Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Peggy El-Mallakh

Clinical Mentor

Dr. Abner O. Rayapati

Committee Member

Dr. Chizimuzo Okoli

Abstract

PURPOSE: Delirium remains a common consequence of critical illness and is known to cause negative patient outcomes during an intensive care unit (ICU) stay. Hence, the purpose of this project is to evaluate the outcomes of patients taking psychiatric medications whose medications are abruptly discontinued upon admission to an ICU. Specifically, the outcomes of interest will be altered mental status, length of hospital stay, restraint use and mortality.

METHODS: A correlational analysis using a retrospective chart audit was conducted on 602 patients admitted to the Neurological/ Neurosurgical ICUs at the University of Kentucky Chandler Hospital from January 2015 to December 2015. The proportion of patients who experience delirium in the ICU was examined using frequencies and percentages. Chi-square analysis was used to assess differences in the proportion of patients who experience delirium and the associations between demographics (age, gender, and race), restraint use, admitting diagnosis, mortality, and those who were/were not admitted with psychiatric medication. Differences in age and length of stay were examined using independent sample t-tests.

RESULTS: Those who had psychiatric medications on admission were significantly more likely to be female (65.9% vs. 44.7%) and to have a diagnosis of a mood disorder (29.5% vs. 12.1%) and anxiety (21.6% vs. 9.3%) disorder. There were no significant differences in length of stay, delirium and/or altered mental status, restraint use, and mortality between those with and without psychiatric medications on admission. As compared to those without delirium, those with delirium were significantly more likely to have a Glasgow coma scale score of 13 or less (68.6% vs. 43.9%), to have restraint use (74.5% vs. 37.2%), to be on an antipsychotic (37.3% vs. 11.6%) or anxiolytic (70.6% vs. 35.9%) medication, and have longer length of stay (19.9 days vs. 9.6 days).

CONCLUSION: There is limited research concerning the treatment of delirium and pre-existing psychiatric conditions. Further research is needed to assess if abrupt discontinuation of psychiatric medications has any association with delirium.

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