Drug Utilization Pharmacist & Pharmacy Research Coordinator Nova Scotia Health Halifax, Canada
Background: In the hospital setting, falls frequently occur and can result in an injury and prolonged length of stay. One risk factor for falls is the use of sedative-hypnotic drugs (SHD), which are commonly used in the hospital for insomnia.
Objectives: To compare SHD utilization among two Canadian hospitals for benchmarking and identification of areas of concern for further study.
Methods: A retrospective drug use evaluation (DUE) was conducted in two community hospitals, the Queensway Carleton (QCH) in Ottawa, Ontario and the Dartmouth General (DGH) in Dartmouth, Nova Scotia.
Results: SHD use was calculated as defined daily doses (DDD)/100 patient-days (PD) for calendar years 2018 and 2019. SHD usage was higher in DGH (22.64 DDD/100 PD in 2018 and 19.79 DDD/100 PD in 2019) compared to QCH (16.44 DDD/100 PD in 2018 and 15.98 DDD/100 PD in 2019). While total annual SHD usage decreased in both hospitals in 2019, surgery and geriatric services increased SHD utilization in QCH. The top SHD at QCH were trazodone, lorazepam, and zopiclone (6.00, 4.38, and 3.27 DDD/100 PD in 2019, respectively). The most frequently used SHD at DGH were zopiclone, lorazepam, and diazepam (9.56, 4.65, and 1.76 DDD/100 PD in 2019, respectively). An additional analysis using a 50 mg prescribed daily dose (PDD) for trazodone increased the rates to 45.99 PDD/100 PD for QCH and 26.35 PDD/100 PD for DGH in 2019.
Conclusions: The DUE found an overall declining trend in prescribing but differences in both the rates of use by service and the preferred SHD among the two hospitals. Reporting drug utilization using a standardized measure allowed for benchmarking and comparisons but may be influenced by the prescribed daily dose. The results highlight potential areas, such as the geriatrics service, for clinicians to focus for quality improvement and safer prescribing for hospital patients.
