Patient‐reported factors associated with the desire to continue taking sleep‐inducing drugs after hospital discharge: A survey of older adults

Klemperer²,

Hummers³

et al. 2021

Preprint

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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 in-tervention 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 interven-tion 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.

Section: Sample-size Calculation and Statistical Analysismentioning

confidence: 99%

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

Klemperer²,

Hummers³

et al. 2021

Preprint

Self Cite

“…For example, a hospital chart review showed that 12% of all patients 65 and older received a Z-drug at least once during their stay [11]. A patient survey in the same hospital revealed that more than half of the older patients who received Z-drugs in the hospital wished to continue taking these drugs at home [12].…”

Section: Context: the Sleeping Pills Projectmentioning

confidence: 99%

“…Chart review studies give us an idea of how hospital doctors usually solve this conflict; they often prescribe benzodiazepines and newer non-benzodiazepines (so-called Z-drugs) for patients who have trouble sleeping [3][4][5]. While these drugs may help patients to sleep in the hospital environment, they also have adverse effects, such as confusion, falls, fractures, and craving [6] so they are not recommended for the treatment of transient sleep problems in most guidelines [7].…”

Section: Introductionmentioning

confidence: 99%

Why Z-drugs are used even if doctors and nurses feel unable to judge their benefits and risks—a hospital survey

Brockmöller

Hagmayer

et al. 2019

Eur J Clin Pharmacol

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Background Many patients receive Z-drugs for hospital-associated sleep problems, in spite of well-known risks. The aim of this study was to learn more about the attractiveness of Z-drugs, seen from the doctors' and nurses' perspective. Methods Using a standardized questionnaire, doctors (63/116) and nurses (73/243) in a German general hospital were surveyed about the risks and benefits of Z-drugs, compared with benzodiazepines. Result "Reduced time to get to sleep" was perceived by doctors (51%) and nurses (53%) to be a strong benefit of Z-drugs; "confusion" and "falls" were perceived by ca. 10% of doctors and ca. 15% of nurses to be a frequent problem. Compared with benzodiazepines, respondents more often answered "unable to judge" for Z-drugs; e.g. for doctors, 18% (benzodiazepines) vs. 45% (Z-drugs) were unable to judge "improved daytime functioning" and 12% (benzodiazepines) vs. 37% (Z-drugs) were unable to judge "falls." Conclusion Z-drugs seem to be attractive because experiential knowledge overemphasizes their benefits and fails to take risks such as drug-related falls and confusion into account. Difficulties to judge a drug's risk-benefit ratio do not prevent doctors and nurses from using them. Interventions for reducing Z-drug usage should incorporate local quality assurance data about relevant patient risks.

“…Weiterhin können sie kognitive Einschränkungen nach sich ziehen (Atkin, Comai & Gobbi, 2018). Schließlich kann die Erfahrung, mit Hilfe von Medikamenten einfach einschlafen zu können, einen ungünstigen Lernprozess für zukünftige Schlafprobleme anstoßen (Heinemann, Neukirchen, Nau, Hummers & Himmel, 2019) und eine dauerhafte Medikamenteneinnahme oder -abhängigkeit einleiten.…”

Section: Introductionunclassified

Erfahrungen im Umgang mit Schlafmitteln: Gruppendiskussionen mit Auszubildenden in der Pflege über Benzodiazepine und Z-Substanzen

Kasper-Deußen

Weiss

et al. 2022

Pflege

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Zusammenfassung. Hintergrund und Zielsetzung: Die Linderung von Ein- und Durchschlafproblemen ist eine häufige Herausforderung im Krankenhaus. Ziel dieser Studie war es herauszuarbeiten, wie Auszubildende in der Gesundheits- und Krankenpflege Schlafprobleme von Patientinnen und Patienten und den Einsatz von Schlafmitteln, insbesondere von Benzodiazepinen und Z-Substanzen, erleben. Methoden: In vier Gruppendiskussionen wurden die Erfahrungen von Auszubildenden erhoben. Die Transkripte der Diskussionen wurden mittels dokumentarischer Methode ausgewertet und nach abschließender inhaltsanalytischer Verdichtung zu Hauptkategorien zusammengefasst. Ergebnisse: Die Auszubildenden erleben eine großzügige Gabe von Schlafmitteln, die – trotz geringer Evidenz – seitens der Pflege als bestmögliche Lösung von Schlafproblemen angesehen wird. Nicht-medikamentöse Alternativen werden selten gelehrt, sind oft nicht vorrätig und ihr Einsatz wird kaum trainiert. Das pharmakologische Wissen der Auszubildenden ist teilweise gering bzw. gelingt die Umsetzung in die Praxis nur bedingt. Schlaf und Schlafprobleme sind, z. B. im Vergleich zur Schmerzbehandlung, keine prioritären Themen im Krankenhaus. Schlussfolgerungen: Mehr Wissen und größere Sensibilität gegenüber Schlafproblemen sind erforderlich. Beispielhaft sollte in der Ausbildung gezeigt werden, wie das Wissen über Medikamente und Alternativen sinnvoll in Problemsituationen angewandt werden können – hier sind gute Vorbilder auf ärztlicher und / oder pflegerischer Seite gefragt.