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Background Benzodiazepines and sedative-hypnotics (BZD/SHD) are commonly utilized in the acute care setting for insomnia and anxiety and are associated with cognitive impairment, falls, fractures, and increased mortality. Interventions to reduce use of BZD/SHD in hospitals are not well characterized. The objective of the scoping review was to identify and characterize interventions to reduce the use of BZD/SHD by adults for anxiety and sedation in hospitals.Methods We included studies and abstracts published in English that described an intervention to reduce BZD/SHD in adult hospital patients. Six databases (PubMed, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science) and the grey literature (Opengrey, Grey Matters, Google Advanced) were searched up to July 2018. Titles and abstracts were screened and full-text articles were reviewed for potential inclusion by three independent reviewers. Data on each eligible study was charted in a Microsoft Excel® database. Stakeholder consultation occurred before and after the scoping review was completed.Results There were 9480 records identi ed from all sources and 35 studies were included in the scoping review. Included studies were divided into two categories that emerged from stakeholder feedback: sedatives prescribed in hospital or home medications. The most common study designs were pre-/posttest (24, 68.6%) and randomized controlled trials (6, 17.1%). The majority of studies tested a single intervention (28, 80%) and these were most commonly education, relaxation training and sleep protocols. Patients were frequently the target of relaxation training and behavior change interventions, while sleep protocols, multifaceted interventions and education were usually directed at healthcare providers, either alone or in combination with patients. Most studies reported positive outcomes in decreasing BZD/SHD use (23, 65.7%), including some that were statistically signi cant (13, 37.1%).Conclusions This scoping review found a variety of interventions aimed at decreasing the utilization of BZD/SHD in the acute care setting, where previously little was known. Current literature addressed the initiation of BZD/SHD in hospital, rather than chronic medications that had been prescribed in the community. Stakeholder consultation supported these ndings and pointed out important factors to consider when designing an intervention for hospital patients.

Introduction: The Cunningham reduction method for anterior shoulder dislocation offers an atraumatic alternative to traditional reduction techniques without the inconvenience and risk of procedural sedation and analgesia (PSA). Unfortunately, success rates as low as 27% have limited widespread use of this method. Inhaled methoxyflurane (I-MEOF) offers a rapidly administered, minimally invasive option for short-term analgesia. We conducted a pilot study to evaluate the feasibility of studying whether I-MEOF increased success rates for atraumatic reduction of anterior shoulder dislocation. Methods: A convenience sample of 20 patients with uncomplicated anterior shoulder dislocations were offered the Cunningham reduction method supported by methoxyflurane analgesia under the guidance of an advanced care paramedic. Operators were instructed to limit their attempt to the Cunningham method. Outcomes included success rate without the requirement for PSA, time to discharge, and operator and patient satisfaction with the procedure. Results: 20 patients received I-MEOF and an attempt at Cunningham reduction. 80% of patients were male, median age was 38.6 (range 18-71), and 55% were first dislocations of that joint. 35% (8/20 patients) had reduction successfully achieved by the Cunningham method under I-MEOF analgesia. The remainder proceeded to closed reduction under PSA. All patients had eventual successful reduction in the ED. 60% of operators reported good to excellent satisfaction with the process, with inadequate muscle relaxation being identified as the primary cause of failed initial attempts. 80% of patients reported good to excellent satisfaction. Conclusion: Success with the Cunningham technique was marginally increased with the use of I-MEOF, although 65% of patients still required PSA to facilitate reduction. The process was generally met with satisfaction by both providers and patients, suggesting that early administration of analgesia is appreciated. Moreover, one-third of patients had reduction achieved atraumatically without need for further intervention. A larger, randomized study may identify patient characteristics which make this reduction method more likely to be successful.

Background Benzodiazepines and sedative-hypnotics (BZD/SHD) are commonly utilized in the acute care setting for insomnia and anxiety and are associated with cognitive impairment, falls, fractures, and increased mortality. Interventions to reduce use of BZD/SHD in hospitals are not well characterized. The objective of the scoping review was to identify and characterize interventions to reduce the use of BZD/SHD by adults for anxiety and sedation in hospitals.Methods We included studies and abstracts published in English that described an intervention to reduce BZD/SHD in adult hospital patients. Six databases (PubMed, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science) and the grey literature (Opengrey, Grey Matters, Google Advanced) were searched up to July 2018. Titles and abstracts were screened and full-text articles were reviewed for potential inclusion by three independent reviewers. Data on each eligible study was charted in a Microsoft Excel® database. Stakeholder consultation occurred before and after the scoping review was completed. Results There were 9480 records identified from all sources and 35 studies were included in the scoping review. Included studies were divided into two categories that emerged from stakeholder feedback: sedatives prescribed in hospital or home medications. The most common study designs were pre-/post-test (24, 68.6%) and randomized controlled trials (6, 17.1%). The majority of studies tested a single intervention (28, 80%) and these were most commonly education, relaxation training and sleep protocols. Patients were frequently the target of relaxation training and behavior change interventions, while sleep protocols, multifaceted interventions and education were usually directed at healthcare providers, either alone or in combination with patients. Most studies reported positive outcomes in decreasing BZD/SHD use (23, 65.7%), including some that were statistically significant (13, 37.1%). Conclusions This scoping review found a variety of interventions aimed at decreasing the utilization of BZD/SHD in the acute care setting, where previously little was known. Current literature addressed the initiation of BZD/SHD in hospital, rather than chronic medications that had been prescribed in the community. Stakeholder consultation supported these findings and pointed out important factors to consider when designing an intervention for hospital patients. Registration: Open Science Framework, https://osf.io/u7s4h/?view_only=15a9b9134be743b6a4177ba2eec9e91a