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Delirium clinical care standard indicators: 6b-Proportion of patients with delirium prescribed antipsychotic medicines in hospital

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termIndicator 6b-Proportion of patients with delirium prescribed antipsychotic medicines in hospital
METeOR identifier:Help on this term628110
Registration status:Help on this termHealth, Standard 12/09/2016
Description:Help on this term

Proportion of patients with delirium prescribed antipsychotic medicines in hospital

Rationale:Help on this term

Antipsychotic medicines have a number of serious adverse effects for older people and can worsen delirium (Psychotropic Expert Group 2013; National Institute for Health and Clinical Excellence 2010). Reserving antipsychotic medicines for patients who are severely distressed and in whom non-drug strategies are ineffective may help reduce the incidence of adverse drug events (National Institute for Health and Clinical Excellence 2010; Clinical Epidemiology and Health Service Evaluation Unit 2006). Other psychotropic medicines (e.g. benzodiazepines) are not an appropriate alternative to an antipsychotic medicine (Clinical Epidemiology and Health Service Evaluation Unit 2006; AMH Aged Care Companion 2014).

Indicator set:Help on this termClinical care standard indicators: delirium Health, Standard 12/09/2016
Outcome area:Help on this termMinimising use of antipsychotic medicines Health, Standard 12/09/2016

Collection and usage attributes

Computation description:Help on this term

The numerator includes patients with delirium for whom a comprehensive assessment to investigate the cause(s) of their delirium is undertaken during the hospital stay and is documented in their medical record.

Unless explicitly stated in the indicator, all patients with delirium are included in both the numerator and the denominator, not only those where Hospital service—care type, code N[N] = 1 Acute care.

Presented as a percentage.

Computation:Help on this term

(Numerator ÷ denominator) x 100

Numerator:Help on this term

Number of patients with delirium for whom an antipsychotic medicine was prescribed during the hospital admission.

Denominator:Help on this term

Number of patients with delirium.

Comments:Help on this term

Antipsychotics medicines include (Psychotropic Expert Group 2013; ACI 2014): haloperidol, olanzapine, quetiapine, risperidone, amisulpride, aripiprazole, asenapine, chlorpromazine, clozapine, droperidol, flupenthixol, fluphenazine, paliperidone, pericyazine, quetiapine, triifluoperazine, ziprasidone, zuclopenthixole.

This indicator is best derived by obtaining information about prescriptions dispensed from the hospital’s pharmacy system. The most practical way to derive this information is to generate a list of all patients with delirium for the period, and obtain a report from the pharmacy dispensing system of the prescriptions of antipsychotic medicines for these patients.

This indicator has been sourced from the Key principles for care of confused hospitalised older persons (ACI 2014).

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termPerson
Format:Help on this term

N[NN]

Source and reference attributes

Submitting organisation:Help on this term

Australian Commission on Safety and Quality in Health Care

Reference documents:Help on this term

ACI (Agency for Clinical Innovation) 2014. Key Principles for care of confused hospitalised older persons. Sydney: ACI.

AMH Aged Care Companion 2014. Adelaide: Australian Medicines Handbook Pty Ltd.

Clinical Epidemiology and Health Service Evaluation Unit 2006. Clinical practice guidelines for the management of delirium in older people. Melbourne: Victorian Government Department of Human Services on behalf of AHMAC. Viewed 5 May 2016, http://docs.health.vic.gov.au/docs/doc/
A9F4D074829CD75ACA25785200120044/$FILE/delirium-cpg.pdf
.

National Institute for Health and Clinical Excellence 2010. Delirium: diagnosis, prevention and management; Clinical guideline 103. London: NICE.

Psychotropic Expert Group 2013. Therapeutic guidelines: psychotropic version 7. Melbourne: Therapeutic Guidelines Limited. Viewed 5 May 2016,  http://www.tg.org.au/index.php?sectionid=48.

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