Reducing the use of sleep-inducing drugs during hospitalization by a multi-faceted intervention – a pilot study

Abstract

ABSTRACTObjectivesMany patients receive benzodiazepines or Z-drugs during hospitalization due to sleeping problems. In a pilot study, we aimed to find out whether, and to what degree, a multi-faceted intervention can reduce the use of these drugs, especially in older patients and those without a psychiatric or neurological disorder. The results of this pilot study should inform the design of a randomised controlled trial (RCT).MethodsIn a quasi-experimental design, we implemented the intervention in a German hospital with the support of the hospital director, medical and nursing staff and employee representatives. We compared prescription data for sleep-inducing drugs before and after the intervention by Fisher’s exact test and used Odds-Ratios (ORs) with their 95 % confidence intervals (CI) as measure of effect size.ResultsThe data from 960 patients aged 65 and older before intervention and 1049 patients after intervention were analysed. Before intervention, 483 (50.3%) of the patients received sleep-inducing drugs at some time during their hospital stay. After the intervention, 381 (36.3%) patients received a sleep-inducing drug, resulting in an OR of 0.56 (95% CI: 0.47 to 0.68; p <0.001). The reduction was particularly pronounced in patients without a psychiatric or neurological disorder (from 45.0% to 28.8%). Especially benzodiazepines were significantly reduced (from 24.3% to 8.5%; OR: 0.31 (0.23-0.4); <0.001).ConclusionsA multi-faceted intervention to change the practice of the use of sleep-inducing drugs in one hospital was successful in terms of drug reduction, particularly for benzodiazepines. The intervention was effective especially for target persons, i.e. those without a psychiatric or neurological disease. Being aware of the magnitude of the change and the role of important stakeholders could help researchers, hospital physicians and hospital pharmacists to design a large RCT, including control hospitals, to evaluate the success of a multi-faceted intervention on a scientifically sound basis.KEY MESSAGESWhat is already known on this subjectBenzodiazepines and Z-drugs are still too often used for sleep problems in hospitals.Simple interventions, such as training seminars to reduce the use of benzodiazepines, Z-drugs, and other drugs for insomnia treatment are limited in their effect.What this study addsThe intervention significantly reduced the rate of sleep-inducing drugs by 14 percentage points.The results of this pilot study give a first impression of the possible impact of the interventions and provide essential information for the design of a randomized controlled study.