Drug Utilization Pharmacist & Pharmacy Research Coordinator Nova Scotia Health Halifax, Canada
Background: Sedative-hypnotic drugs (SHDs) are commonly prescribed to hospitalized patients to manage insomnia. Older adults are particularly vulnerable to adverse effects such as impaired coordination which can lead to falls and fractures.
Objectives: To assess the feasibility of conducting a structured medication assessment of falls risk increasing drugs (FRIDs) to deprescribe SHDs in hospitalized patients.
Methods: A standardized medication assessment form evaluating SHD use and fall risk was developed and incorporated into clinical pharmacy practice on 4 pilot units within Nova Scotia Health, Canada. The form was completed by a pharmacy student or pharmacist, which gathered patient demographics, fall history, risk factors such as impaired mobility, and use of SHD and FRIDs. For each assessment, deprescribing recommendations were made to the care team and discussed with the patient.
Results: Thirty-two patients (mean age 77.5 years) were assessed from August 4 to September 28, 2022. Each pilot unit completed 6 to 10 assessments. Patients were prescribed a mean of 1.2 SHDs and 4.9 concurrent FRIDs, and 59.4% had a falls history. Twenty-four assessments (75%) resulted in 32 recommendations to deprescribe an SHD, of which 25 (78.1%) were accepted. Recommendations were not accepted by patients (2), the healthcare team (3), or outcomes were unknown (2). Nineteen of the 32 patients (59.4%) had SHDs initiated during their hospital stay. After assessment, 15 recommendations to stop or reduce the dose of the SHD were made and 13 (86.7%) were accepted.
Conclusions: A structured medication assessment to evaluate SHD use and fall risk factors identified deprescribing opportunities in hospital and most recommendations were accepted by inpatient care teams. Patient acceptance of deprescribing is an important factor in success. Pharmacists’ attitudes toward the tool and ability to consistently incorporate into clinical practice will be assessed.
