Reducing Sedative-Hypnotics Among Hospitalized Patients: a Multi-centered Study.
J Gen Intern Med
; 37(10): 2345-2350, 2022 08.
Article
em En
| MEDLINE
| ID: mdl-34981347
ABSTRACT
BACKGROUND:
Sedative-hypnotics are frequently prescribed for insomnia in hospital but are associated with preventable harms. OBJECTIVE, DESIGN, ANDPARTICIPANTS:
We aimed to examine whether a sedative-hypnotic reduction quality improvement bundle decreases the rate of sedative-hypnotic use among hospitalized patients, who were previously naïve to sedative-hypnotics. This interrupted time series study occurred between May 2016 and January 2019. Control data for 1 year prior to implementation and intervention data for at least 16 months were collected. The study occurred on 7 inpatient wards (general medicine, cardiology, nephrology, general surgery, and cardiovascular surgery wards) across 5 teaching hospitals in Toronto, Canada. INTERVENTION Participating wards implemented a sedative-hypnotic reduction bundle (i.e., order set changes, audit-feedback, pharmacist-enabled medication reviews, sleep hygiene, daily sleep huddles, and staff/patient/family education) aimed to reduce in-hospital sedative-hypnotic initiation for insomnia in patients who were previously naïve to sedative-hypnotics. Each inpatient ward adapted the bundle prior to sustaining the intervention for a minimum of 16 months. MAINMEASURES:
The primary outcome measure was the proportion of sedative-hypnotic-naïve inpatients newly prescribed a sedative-hypnotic for sleep in hospital. Secondary measures include prescribing rates of other sedating medications, fall rates, length of stay, and mortality. KEYRESULTS:
We included 8,970 patient discharges in the control period and 10,120 in the intervention period. Adjusted sedative-hypnotic prescriptions among naïve patients decreased from 15.48% (95% CI 6.09-19.42) to 9.08% (p<0.001) (adjusted OR 0.814; 95% CI 0.667-0.993, p=0.042). Unchanged secondary outcomes included mortality (adjusted OR 1.089; 95% CI 0.786-1.508, p=0.608), falls (adjusted rate ratio 0.819; 95% CI 0.625-1.073, p=0.148), or other sedating drug prescriptions (adjusted OR 1.046; 95% CI 0.873-1.252, p=0.627).CONCLUSIONS:
A sedative-hypnotic reduction quality improvement bundle implemented across 5 hospitals was associated with a sustained reduction in sedative-hypnotic prescriptions.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Distúrbios do Início e da Manutenção do Sono
Tipo de estudo:
Clinical_trials
Limite:
Humans
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Canadá