Category: Professional Posters
Purpose: In light of FDA warnings as well as the recognition of the potential increased risk for falls and other safety concerns in patients receiving sedative/hypnotics as inpatients, the need to evaluate and optimize the use of sleep medications has been recognized. A determination was made to conduct a review and to limit the number of patients who were not on sleepers at home from starting sedative/hypnotic therapy as an inpatient, reduce the dose of those patients’ already on sedative/hypnotics to a safe level and reduce falls and falls with injury from sedative/hypnotics.
Methods: A retrospective review of 50 patients on sleepers was conducted for 45 days to evaluate if these patients were on a sedative/hypnotic at home, if the patient had fallen at home, if the dose was consistent with the dosage they were on at home, and the assessment of safety and efficacy of medication administration as an inpatient. The results of the retrospective study indicated that 30 patients currently on a sedative/hypnotic were not on a similar medication at home and 63% of these patients did not use the medication during the current inpatient stay. Most concerning, 16.6% patients received a prescription for a sedative/hypnotic when discharged who had not previously been on this therapy and 25% of patients who fell during this time period were on a sedative/hypnotic. Finally, 45% of zolpidem purchases were for 10 mg doses during the retrospective period.
Results: In order to change these trends, education was developed for both physicians and nursing staff. A question to the intervention database was added so that data could be collected about patient falls on sedative/hypnotics. Computer physician order entry order sets were developed for physicians and other licensed healthcare professionals to indicate appropriate dosing based on age and gender which follow the FDA guidelines. Alternative medications including, trazodone, doxepin and melatonin were introduced to the healthcare providers as safe and effective alternatives. Flowsheets were developed for both nursing and licensed healthcare professionals which provided step by step processes to decrease the number of sedative/hypnotics ordered. As a result, purchases of zolpidem 10 mg decreased by 14% and the purchases of melatonin increased by 100%. Falls declined at all treatment sites as well as falls with injury.
Conclusion: This intervention program involved a multidisciplinary approach to the reduction of sedative/hypnotic usage which is imperative for success. Education for patients who are utilizing these medications at home needs to be provided at every opportunity during the inpatient stay. The reduction of new and continuing orders for traditional sedative/hypnotics is essential to reduce at home usage, decrease potential risk of fall and fall with injury, as well as other adverse events related to sedative/hypnotic usage, and potential readmission are all benefits of this intervention program.