Aims
To evaluate antipsychotic prescribing within the first 24 hours of Emergency Department (ED) admission in older adults, assess concordance with local guidelines, and identify opportunities for quality improvement.
Methods
A retrospective observational study was conducted at a tertiary Sydney hospital. Patients aged ≥75 years who received droperidol, haloperidol, olanzapine, quetiapine, or risperidone within 24 hours of ED presentation between January and December 2023 were included. Patients prescribed these agents for chronic psychiatric conditions, end-of-life care, or nausea were excluded. Data were extracted from electronic medical records (EMR) and included demographics, comorbidities, frailty, cognitive status, prescribing patterns, documented indications, consent, use of non-pharmacological strategies, and specialist involvement.
Results
Of 472 screened patients, 228 met inclusion criteria (median age 86 years; 62.7% with dementia; 77.6% severely comorbid; 49.1% severely frail). The most common indication for antipsychotic use was non-specific agitation (25%); however, indication was not documented in 23.6% of cases and consent was not documented in 93.9%. Non-pharmacological strategies were recorded in 26.3%. Multiple antipsychotics were administered to 20.6% of patients, and parenteral agents were used in 55.7% with doses occasionally exceeding local guidelines. Specialist advice was sought in 18.4% of cases but not followed in one-third.
Conclusion
When antipsychotics were used in older adults admitted via the ED documentation of indication, non-pharmacological management and consent were often lacking. These findings highlight the need for improved education, stronger adherence to protocols, enhanced documentation, and multidisciplinary engagement to prioritise non-pharmacological care and improve patient safety.