Nearly half of new psychoactive prescribing after intensive care discharge lacks a documented diagnosis

A US claims-database cohort of 7,898 mechanically ventilated intensive care survivors examined psychoactive medication prescribing after discharge Audit/Data. 5.3% were newly prescribed a psychoactive medication within 30 days of discharge; of these, 43% lacked a documented supporting diagnosis, rising to 52% for antipsychotics specifically. Prescribing without a documented justification persisted for up to two years after discharge and was more likely among patients discharged home.

This is a US insurance-based claims cohort, so the specific prescribing rates should not be assumed to transfer directly to another health system. What is transferable is the audit methodology: a diagnosis-linked medication review at the point where intensive care handover meets community and primary care follow-up.

For services managing the ICU-to-community transition, this offers a low-cost, replicable quality-improvement model — reviewing whether new psychoactive prescribing at this handover point carries a documented clinical justification — rather than a finding that requires immediate practice change on its own.