2026 Southeastern Residency Conference

Title: Identifying Opportunities to Improve Discharge Prescribing of Newly Initiated Quetiapine During Transitions of Care: A Medication Use Evaluation
Authors: Audra Butler, Bobby Azevedo, Abigayle Campbell

Background: Design a medication use evaluation to assess inappropriate continuation of inpatient-initiated quetiapine at hospital discharge and identify transition-of-care points where pharmacy interventions may reduce unnecessary continuation. 

Methods: This medication use evaluation included a retrospective review of patients discharged between October 1 and December 31, 2025. Data was collected to identify cases in which quetiapine was newly initiated during hospitalization for indications such as agitation, delirium, sedation, or insomnia. Patients were excluded if quetiapine was documented as a home medication or if it was initiated for alternative psychiatric indications, such as schizophrenia and bipolar disorder. Different variables were gathered to evaluate prescribing patterns included initiating and discharging provider, location of prescribing at initiation and discharge, physician specialty group (example: family medicine, hospitalist, intensivist), and documentation of whether a pharmacist was involved with medication reconciliation/review at discharge. Raw data was analyzed to assess correlations in prescribing patterns and factors associated with continuation of quetiapine at discharge. 

Results: A review of prescribing patterns revealed that approximately 25 of the 45 patients started on quetiapine while inpatient for an off label indication were inappropriately continued on therapy at discharge. This indicates that more than half of patients lacked appropriate reassessment or discontinuation of therapy prior to transition of care. Additionally, among the 18 patients with dementia who were newly started on quetiapine during their hospital stay, 9 patients (50%) remained on the medication after discharge for an off label indication.  Additionally, when stratifying the intended short-term inpatient indications among the 25 patients inappropriately continued on quetiapine at discharge, 19 patients were treated for agitation/delirium and 6 patients were treated for insomnia. Regarding pharmacist involvement at the time of discharge for patients that were continued inappropriately on quetiapine at discharge, a pharmacist participated in medication review for 10 patients, while 15 patients had no documented pharmacist involvement.

Conclusions: The high rate of inappropriate continuation of inpatient-initiated quetiapine beyond its intended short-term use at discharge represents a significant patient safety issue and underscores a critical gap in current medication reconciliation practices. This concern is amplified in vulnerable populations, particularly patients with dementia, where continued antipsychotic use carries substantial risk. Given that antipsychotic use in patients with dementia is associated with increased risks, including cerebrovascular events and mortality, this finding is particularly concerning. These findings support the need for targeted interventions, including education to hospitalist and family medicine residents, increased pharmacist involvement in discharge planning, routine reassessment of medications initiated for acute inpatient indications, and improved documentation regarding intended duration of therapy. Implementing these strategies may reduce unnecessary antipsychotic exposure, limit polypharmacy, and decrease the likelihood of adverse drug events and poor clinical outcomes. Strengthening discharge processes is essential to ensure safer transitions of care and promote more appropriate, patient-centered medication management.