1233: An Antipsychotic Stewardship Program to Decrease Quetiapine Use in a Pediatric Cardiac Icu

Introduction: Delirium is a common and serious complication for patients in the Pediatric Cardiac Intensive Care Unit (PCICU) and is associated with poorer outcomes. Quetiapine is a antipsychotic used to manage patients with severe or refractory symptoms, however this can pose significant safety risks including metabolic changes, movement disorders, and cardiac arrhythmias. Recognizing our high utilization rates, we aimed to reduce quetiapine exposure by implementing an antipsychotic stewardship program (APSP). Our SMART aim was to reduce the use of quetiapine days per patient days in the PCICU by 10% over 1 year. Methods: Following the core elements of stewardship – leadership commitment, accountability, drug expertise, action to improve medication use, tracking and reporting, and education – we initiated a unit-based multidisciplinary quality improvement project to reduce quetiapine use in our PCICU. After a baseline period (July 2023-June 2024) was observed, we implemented several Plan-Do-Study-Act cycles starting July 2024. Interventions included provider education on delirium risk factors and quetiapine side effects; development of a delirium pathway prioritizing non-pharmacological strategies and earlier weaning of delirium medications once in use; and creation of a standardized, pharmacist-led quetiapine weaning order set. We tracked quetiapine days per 100 patient days on a statistical process control u-chart, which was shared with stakeholders monthly to drive improvement. Results: Prior to the intervention, our PCICU averaged 0.12 quetiapine days per 100 patient days. After the program began in July 2024, a downward shift in the u-chart center line was observed, indicating a significant process change. The post-implementation center line decreased by 81% to 0.023 quetiapine days per 100 patient days. Review of balancing measures confirmed this reduction was not associated with an increase in delirium scores following these changes. Conclusions: The implementation of a multidisciplinary antipsychotic stewardship program is an effective strategy for reducing quetiapine use in critically ill children with cardiac disease. Standardizing care through education, clinical pathways, and data feedback is crucial for changing prescribing practices and enhancing medication safety.