Environmental scan of current strategies to decrease sedative-hypnotic drug use and promote sleep in hospital patients

Int J Clin Pharm. 2023 Oct;45(5):1062-1073. doi: 10.1007/s11096-023-01632-7. Epub 2023 Sep 29.

Abstract

Background: Sedative-hypnotic drugs are often initiated in hospital to manage insomnia and anxiety. Guidelines discourage their use, particularly in older adults, due to risks of falls, fractures, and delirium.

Aim: To identify publicly available resources to decrease the use of sedative-hypnotic drugs and promote sleep in hospital.

Method: An advanced Google search with 6 search strategies was conducted. Key websites were also identified and searched. Hospital- or community-based resources using non-pharmacologic measures to reduce sedative-hypnotic drug use and/or to promote sleep were included if they were publicly available in English within the past 5 years. Full text screening and data extraction was performed independently by 2 reviewers; a third reviewer resolved disagreements by consensus.

Results: A total of 79 resources met inclusion criteria, with 65 (82.3%) providing education and 31 (39.2%) describing sleep hygiene strategies. Other resources included deprescribing (17, 21.5%), relaxation training (13, 16.5%), cognitive behavioural therapy for insomnia (9, 11.4%), and policies (7, 8.9%). The resources primarily targeted patients (59, 74.7%) followed by healthcare providers (9, 11.4%). There were 9 resources (11.4%) that applied to both community and hospital settings, and another 2 (2.5%) designed specifically for hospital.

Conclusion: Many resources were available to patients and healthcare providers to reduce inappropriate or ineffective use of sedative-hypnotic drugs and promote better sleep. Specific resources for the hospital setting were infrequent and recommended that clinicians stop hospital-initiated sedatives when patients are discharged. Identified resources can be adapted by healthcare organizations to develop sedative-hypnotic prescribing programs and policies.

Keywords: Deprescribing; Hospital; Insomnia; Non-pharmacologic therapy; Sedative-hypnotic; Sleep.

Publication types

  • Review

MeSH terms

  • Aged
  • Anxiety Disorders
  • Hospitals
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Sleep
  • Sleep Initiation and Maintenance Disorders* / drug therapy

Substances

  • Hypnotics and Sedatives