3068 Promoting the reduction of sedative use in older adults with delirium—a QI project

Abstract

Introduction Non-pharmacological de-escalation techniques are effective in managing agitated patients with delirium yet are often overlooked in favour of pharmacological management. Sedatives are prescribed despite increased falls and extrapyramidal side effects. We used quality improvement methodology with the aim of reducing sedative use in older adults with delirium in an acute UK hospital. Methods Utilising inpatient electronic prescribing records, we collected data on all patients aged ≥65 prescribed a sedative acutely during May 2022 in a 575-bedded acute district general hospital. Based on best-practice guidelines, formulated standards were: <10 cases of sedatives prescribed monthly, and in individuals with sedatives prescribed 100% screened for delirium, 90% have non-pharmacological delirium management methods trialled first, 100% have rationale for sedative prescription documented, and 100% of sedative prescriptions reviewed within 24 hours. Of cases prescribed a benzodiazepine, 100% should have contraindication to haloperidol documented. We conducted one Plan-Do-Study-Act (PDSA) cycle, focussing on hospital-wide education and the implementation of aide-memoires, and repeated our audit in May 2024. Results Total sedatives prescribed declined significantly at re-audit (42 vs 72), with 28 individuals meeting inclusion criteria (vs 36 at baseline). Rates of delirium screening remained static (93%) while documentation of non-pharmacological methods improved by 16%. Where sedatives were used, 21% of prescriptions lacked documentation of rationale (vs 14% at baseline), no instances of contraindication to haloperidol were recorded (vs 6%), and only 68% of prescriptions were reviewed within 24 hours (vs 75%). Sedation for a scan reduced by the largest margin (18% of prescriptions vs 34%). Conclusions The total number of sedatives prescribed decreased through education initiatives. Where prescribed, fewer standards were met, including fewer documentations of rationale and medication reviews. Future work will be to implement an electronic prescribing sedative care plan to encourage non-pharmacological de-escalation techniques prior to consideration of appropriate, time-limited sedative prescriptions.