Problem: Antipsychotics are frequently prescribed for behavioural and psychological symptoms of dementia (BPSD) and delirium despite limited long-term efficacy and significant adverse effects. National standards emphasize documentation of deprescribing advice, review timeframes and communication to community clinicians, yet discharge summaries often fail to include this information.
Design/methods: We conducted an audit of discharge summaries from an acute geriatric unit in a tertiary hospital across three periods: pre-intervention (June–September 2024), intervention (September–December 2024) and post-intervention (December 2024–May 2025). Summaries for patients with delirium, a prior diagnosis of dementia and/or history of BPSD discharged on antipsychotics were reviewed for documentation of deprescribing advice and planned clinician and timeframe review. Interventions included departmental communications, education sessions and pharmacist engagement.
Practice change: Multimodal prompts and pharmacist involvement were implemented to improve documentation of antipsychotic deprescribing advice and follow-up plans in discharge summaries.
Re-audit: In the six-month post-intervention period, 265 discharge summaries were reviewed; 36 patients were discharged on antipsychotics. Deprescribing advice to general practitioners was documented in 56% of summaries, compared with 14% pre-intervention. Documentation of a planned reviewing clinician increased from 39% to 61% and inclusion of a review timeframe increased from 0% to 36%. Advice to patients or carers remained infrequent.
Conclusions: Documentation of antipsychotic deprescribing advice and follow-up planning improved in the post-intervention period. Improvements were partly influenced by system-level factors including pharmacist availability. More structured and sustained approaches including streamlined discharge processes, adequate pharmacist resourcing and EMR-integrated templates could improve the consistency and quality of antipsychotic deprescribing communication following hospitalization.