Background: The Intensive Care Unit (ICU) can be both a frightening and disorientating experience for patients. In the awake patient, sedative medications are often used to treat agitation and delirium or sleep disturbance. There are at present no widely accepted guidelines on oral sedative use in the ICU. This study assessed how oral sedatives are being used and whether their use resulted in an increased incidence of falls after discharge to the ward.
Sampling methods: We analysed sixteen months (1st January 2011 – 30th April 2012) of admissions data to the ICU of a large teaching hospital in the West Midlands. Patients aged 80 years or older at the time of admission to intensive care were identified using the Intensive Care National & Research Centre (ICNARC) database. Prescribing information and falls data were collected using the hospital's Patient Information & Communication System (PICS).
Results: We collected data for 187 patient episodes. Data was analysed according to admission type (Surgical emergency 56, Medical emergency 71, Elective 60). In the study population as a whole, 56/187 (29.9%) received a sedative medication during their ICU stay. The highest sedative burden was seen in the medical emergency group with 31/71 (44%). Benzodiazepines were the most commonly used agents accounting for 44/95 (46.3%) of all sedative prescriptions. Antipsychotic use was also commonplace with 42/95 (44.2%) of patients being prescribed one. In the medical cohort of patients, 17/27 (63%) had their benzodiazepine continued on discharge from ICU. This group had the highest incidence of falls 11/46 (23.9%).
Conclusion: This study demonstrates that the use of oral sedative medication in the extreme elderly admitted to ICU is commonplace. Medical patients were more likely to be prescribed these medications and the majority have their benzodiazepine prescription continued on discharge to the ward. This was associated with a higher incidence of falls in the medical emergency group.