Potentially inappropriate prescription of hypnotic drugs in the elderly : a quality improvement project

Abstract

INTRODUCTION AND BACKGROUND: Both the American Beers Criteria and the STOPP/START criteria for potentially inappropriate prescribing in older people, have recommended that benzodiazepines and Z-drugs should be avoided in older adults with a history of falls or fractures. Unfortunately, their misuse and overuse remains a worldwide epidemic. An initial audit at our rehabilitation hospital showed a significant increase in the number of patients discharged on hypnotics when compared to admission. To improve our practices we carried out a quality improvement project and a re-audit.

METHODS: Multiple educational interventions were carried out. In a 2nd cycle audit we retrospectively analysed the proportion of geriatric patients admitted versus discharged on hypnotics from our rehabilitation hospital throughout 2022. We assessed for a concurrent history of falls or fractures. Results were compared to the 1st cycle.

RESULTS: 1033 patient records were initially examined. Of those included, 132 (17.6%) were discharged on a hypnotic in the 2nd cycle compared to 183 (19.3%) in the 1st cycle. This change did not reach statistical significance. 55% had adequate documentation of prescription rationale in the 2nd cycle compared to 43% in the 1st cycle (p = 0.046). The majority of patients discharged on treatment had a history of fractures or falls in both cycles.

CONCLUSION: Prescribing practices did not improve significantly following our educational interventions. Whilst educational interventions may help with raising awareness, individually they are often not enough to instil change in practices. Multi-faceted and targeted interventions should be the focus of future attempts at improving outcomes.