139Prevalence of Sedative Medication Use Among Older Patients during Hospital Stay

Abstract

Background: Sedatives (e.g. benzodiazepines and z drugs) are safe and effective for short-term treatment of anxiety and insomnia but can be associated with adverse effects such as falls and confusion, especially among older adults when used long-term. A study done in 2016 by the lead author in a rehabilitation unit in the West of Ireland showed that 1 in 2 patients were prescribed sedatives. This practice was significantly reduced after targeted education of healthcare staff. Our audit aims to determine the prevalence of sedative prescription among older adults admitted to a Model 2 hospital in Dublin. Methods: A review of charts and prescriptions of patients ≥65 years admitted acutely or for rehabilitation was conducted over one week in April 2018. Results: Of 72 eligible inpatients, mean age was 81 years (SD ± 7.9), 55% (n 40) were women. Sedatives were prescribed to 21% (n 15). Two (3%) were on benzodizepine, 4 (5%) on zopiclone, 6 (8%) on zolpidem and 3 (4%) on both benzodiazepine and either zopiclone or zolpidem. Indication for use were insomnia (80%, n 12) and anxiety (20%, n 3). For those on sedatives, 40% (n 6) had history of recurrent falls, 53% (n 8) had poly-pharmacy and 20% (n 3) had delirium with history of dementia. Almost half (47%, n 7) of patients on sedatives were started during admission. Only 2 (13%) had review/stop date. Conclusion: In this cohort, 1 in 5 patients were prescribed sedatives however the majority had contraindications to their use. To further reduce sedative prescription for older patients and minimise their risk of falls and delirium, we plan to provide targeted healthcare staff education regarding non-pharmacologic methods for improving sleep hygiene. This was previously successful in the rehabilitation unit in the West of Ireland. A re-audit will follow to assess the impact of the education sessions.