Delirium Clinical Pathway — CICU, PICU, and PCU

Haloperidol and Quetiapine

Haloperidol (Haldol®): > 3 months of age    

General Haloperidol Titration Approach

  • Increase dose no sooner than the recommended titration frequency by age-based titration increments
  • Assess any PRN haloperidol use over the last 24 hours:
    • If no PRN(s) given, consider PRN and assessing for response before increasing standing dose
    • If PRN(s) required and positive response noted, consider increasing standing dose
  • Determine total cumulative dose of haloperidol given in the last 24 hours and divide q6-12h to determine new standing dose (maximum 0.075 mg/kg/dose)
  • If no improvement is noted with dose escalations, reassess for non-response and consider discontinuation

Quetiapine (Seroquel®): > 3 months of age

General Quetiapine Titration Approach

  • Increase dose no sooner than the recommended titration frequency by weight-based titration increments
  • Assess any PRN quetiapine use over the last 24 hours
    • If no PRN(s) given, consider PRN and assessing for response before increasing standing dose
    • If PRN(s) required and positive response noted, consider increasing standing dose
  • If no improvement is noted with dose escalations, reassess for non-response and consider discontinuation