Interventions to reduce benzodiazepine and sedative-hypnotic drug use in acute care hospitals: A scoping review

Abstract

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.

Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial

“…Another way of supporting deprescribing in the hospital setting would be to target practitioners’ behavior by measuring, reporting, and sharing deprescribing activity [ 49 ]. A recent scoping review on interventions implemented in the acute care setting, but not specific to older adults, reported that multifaceted interventions aimed at patients and healthcare providers that include a combination of education, sleep protocols, and deprescribing may support reductions in benzodiazepine or other sedative/hypnotic drug use [ 18 ].…”

“…A few small studies reported encouraging data showing that engaging with patients during their hospital stay may contribute to increased rates of BZRA deprescribing, but post-discharge data were reported scarce [ 15 – 17 ]. A scoping review from Neville et al recently identified interventions implemented in the acute care setting, but not specifically for older adults [ 18 ]. While the effects of pharmacotherapy optimization approaches on overall rates of potentially inappropriate prescribing have been measured [ 19 ], little is known about how much these global approaches can modify BZRA use during hospitalization and after discharge.…”

Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour (COM-B) Model: a qualitative study

“…Several studies have found that hospitalisation may be an opportune time to review a patient's medications, educate patients and their families on the risks of benzodiazepines, 18 19 and to potentially reduce use of benzodiazepines and sedative-hypnotics. 20 A 2019 study in more than 100 Italian internal medicine and geriatric wards found that from admission to discharge, the prevalence of inappropriate benzodiazepine prescriptions decreased by 4%, demonstrating that some benzodiazepine prescriptions are identified and reduced or stopped during hospitalisation. 21 Another study in three Canadian medical centres found that an intervention using an electronic decision support tool for deprescribing led to an 5% increase in the proportion of patients who were deprescribed benzodiazepines and sedative-hypnotics from admission to discharge.…”

“…This approach has been used with smoking cessation, where this initial pause has been leveraged as an opportunity to quit. Several studies have found that hospitalisation may be an opportune time to review a patient’s medications, educate patients and their families on the risks of benzodiazepines,18 19 and to potentially reduce use of benzodiazepines and sedative-hypnotics 20. A 2019 study in more than 100 Italian internal medicine and geriatric wards found that from admission to discharge, the prevalence of inappropriate benzodiazepine prescriptions decreased by 4%, demonstrating that some benzodiazepine prescriptions are identified and reduced or stopped during hospitalisation 21.…”

Pragmatic trial evaluating the impact of simulation training on high‐risk prescribing to older adults by junior physicians

“…2,[7][8][9][10] For example, interventions have typically focused on educating providers through didactic education alone and do not account for the stress or cognitive overload faced by physicians in caring for acutely ill older adults. [10][11][12] Factors like clinical complexity, perceived pressure from nursing staff and patients, and fatigue can magnify this stress. [13][14][15] This may be especially challenging for less experienced physicians, particularly medical residents.…”