A MULTIMODAL INTERVENTION TO REDUCE THE PRESCRIPTION OF NIGHT SEDATION

Abstract Ref: 
0127

Juliana Delos Reyes, Laura Morrison, Maria Costello, Catherine Crowe, Máirtín Ó
Maoláin, Nichola Moran, Marie-Therese Hanly, Shaun O’Keeffe, Eamon Mulkerrin
Department of Geriatric Medicine, Galway University Hospital, Galway, Ireland

Background: Sedative medications are an independent risk factor for falls in older
patients and also known to reduce alertness and concentration. An initial survey into prescription
of benzodiazepines and Z-drugs found that these medications were prescribed
to 47% of patients admitted to a geriatric medicine rehabilitation unit consecutively over
five months in 2016.

Methods: A multimodal intervention was implemented to reduce need for prescription
of sedative medications. This included education of medical and nursing staff, maintenance
staff involvement to reduce noise within the unit, no caffeinated drinks after 6 pm
and scheduled toileting to reduce disturbance at night.
A retrospective chart review was then performed for all patients admitted for
rehabilitation between 12/01/17 and 11/05/17, two months after introduction of the
intervention.

Results: The repeat survey included 90 patients, mean age 77 years. 54% (n = 49) were
female. Sedatives were prescribed in 16% (n = 14). A benzodiazepine alone was prescribed
in 6% (n = 5), zopiclone alone in 7% (n = 6), zolpidem alone in 1% (n = 1). 2%
(n = 2) were prescribed both a benzodiazepine and either zopiclone/zolpidem. No
patients had been started on these medications or had an increase in dose while in the
rehabilitation unit. A dose reduction had been successfully attempted in 50% (n = 7) of
patients taking these medications before admission to rehabilitation. Further tapering of
the dose was recommended to the GP on discharge for all these patients. None of the
patients started on z-drugs during their acute hospital admission had these medications
prescribed on discharge.

Conclusion: The initial survey showed almost half of patients undergoing rehabilitation
were prescribed sedative medications. This was significantly reduced after introduction
of our multi-modal intervention, with only 16% prescribed these medications
and none of these medications started in the rehabilitation unit. This intervention is
ongoing and will be monitored to ensure continued reduction of prescription of these
medications.