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Reducing unnecessary sedative-hypnotic use among hospitalised older adults
  1. Chris Fan-Lun1,
  2. Clarissa Chung1,
  3. Eun Hye Grace Lee2,
  4. Elisabeth Pek3,
  5. Rebecca Ramsden4,
  6. Cheryl Ethier5,
  7. Christine Soong4,6,7
  1. 1 Pharmacy, Sinai Health System, Toronto, Ontario, Canada
  2. 2 Pharmacy, University of Toronto, Toronto, Ontario, Canada
  3. 3 Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4 General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada
  5. 5 General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada
  6. 6 Institute of Health Policy, Management and Evalulation, Toronto, Ontario, Canada
  7. 7 Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Christine Soong, General Internal Medicine, Mount Sinai Hospital, Toronto, Canada; christine.soong{at}utoronto.ca

Abstract

Background Benzodiazepines and sedative hypnotics (BSH) have numerous adverse effects that can lead to negative outcomes, particularly in vulnerable hospitalised older adults. At our institution, over 15% of hospitalised older adults are prescribed sedative-hypnotics inappropriately. Of these prescriptions, 87% occurred at night to treat insomnia and almost 20% came from standard admission order sets.

Methods We conducted a time-series study from January 2015 to August 2016 among medical and cardiology inpatients following the implementation in August 2015 of a sedative reduction bundle (education, removal of BSH from available admission order sets and non-pharmacological strategies to improve sleep). Preintervention period was January–July 2015 and postintervention period was August 2015–August 2016. A surgical ward served as control. Primary outcome was the proportion of BSH-naive (not on BSH prior to admission) patients 65 years or older discharged from medical and cardiology wards who were prescribed any new BSH for sleep in hospital. Data were analysed on statistical process control (SPC) p-charts with upper and lower limits set at 3δ using standard rules. Secondary measures included Patient-reported Median Sleep Quality scores and rates of fall and sedating drug prescriptions that may be used for sleep (dimenhydrinate).

Results During the study period, there were 5805 and 1115 discharges from the intervention and control units, respectively. From the mean baseline BSH prescription rate of 15.8%, the postintervention period saw an absolute reduction of 8.0% (95% CI 5.6% to 10.3%; p<0.001). Adjusted for temporal trends, the intervention produced a 5.3% absolute reduction in the proportion of patients newly prescribed BSH (95% CI 5.6% to 10.3%; p=0.002). BSH prescription rates remained stable on the control ward. Patient-reported measure of sleep quality, falls and use of other sedating medications remained unchanged throughout the study duration.

Conclusion A comprehensive intervention bundle was associated with a reduction in inappropriate BSH prescriptions among older inpatients.

  • quality improvement
  • medication safety
  • hospital medicine
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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