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

ABSTRACT Objectives Many 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). Methods In 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. Results The 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). Conclusions A 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 MESSAGES What is already known on this subject Benzodiazepines 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 adds The 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.