ANTIPSYCHOTIC STEWARDSHIP FOR OLDER PATIENTS IN ACUTE CARE: PROMOTING APPROPRIATE PRESCRIBING
Bibliographic record
Abstract
Antipsychotics are associated with significant adverse effects and evidence to guide the choice of specific antipsychotic and the appropriate dose in older acutely ill patients is not robust. Our stewardship program is a novel approach to improve appropriateness of antipsychotics in acute care. In addition to the antipsychotic review, the stewardship team offers case-based learning sessions and integrates best practices in delirium management with front-line staff. Other antipsychotic stewardship programs have focused on audit and feedback of prescribing patterns. In contrast, our approach has been to provide education and reinforce non-pharmacologic strategies to behaviour management as an alternative or adjunct to antipsychotic use. In preliminary analysis, 55% of patients receiving antipsychotics were male and 77% of orders were for new prescriptions. Quetiapine and haloperidol were the most frequently ordered antipsychotics at 43% and 41% of orders, respectively. We discontinued or decreased the dose of antipsychotic in 62% of orders.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.040 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".