Evaluation of Sedative-Hypnotic Prescribing Patterns in Hospitalized Older Adults

Abstract

Background: Sedative-hypnotics pose significant harms for older adults yet prescribing of these medications increases with age and may have an association with recent hospitalization. Objectives: To estimate the proportion of older adults admitted to acute care units that are started on a new sedative-hypnotic and the proportion of older adults that received a sedative-hypnotic prescription at discharge. Secondary objectives included describing the prescribing and documentation practices for sedative-hypnotics. Methods: A retrospective study was conducted to identify sedative-hypnotic naïve older adults that were admitted to a medicine, surgery, or cardiology unit with a new order for a sedative-hypnotic drug and whether it was continued at discharge. A convenience sample of 100 patient encounters that received at least 1 dose of the medication were selected to characterize prescribing patterns and documentation practices of sedative-hypnotic orders. Descriptive statistics were used for analysis of all outcome variables. Results: A total of 612 patient encounters had a new sedative-hypnotic order during the study period, representing 8.1% of eligible patients admitted to acute-care floors being evaluated. Of the 612 encounters, 11.3% had the medication continued at discharge. The cardiology and cardiovascular surgery service had the highest number of orders (71%). From the random sample of 100 patients, 67% of orders were for zopiclone and 29% for lorazepam. 30% of orders for zopiclone and lorazepam had a documented indication; 100% of zopiclone orders were for sleep while 45% of lorazepam orders were for sleep, 18% for anxiety and sleep, and 18% for agitation. The mean daily dose prescribed was 5.5 mg for zopiclone and 1 mg for lorazepam. 26% of patients that received a dose of a sedative-hypnotic had the medication continued at discharge. Conclusion: Overall, approximately 1 in 12 sedative-naïve hospitalized older adults were newly ordered a sedative-hypnotic, and of those 11.3% were continued at discharge. This study highlighted high prescribing services and the associated prescribing patterns that can be targeted for interventions to reduce sedative-hypnotic prescribing.