127A Multimodal Intervention to Reduce the Prescription of Night Sedation

Abstract

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.