Guilty! Despite all we say about sedating agents contributing to falls, delirium, and other adverse events in hospitals, we still often write that standing order for a prn sleep med for our inpatients. Worse yet, we often even include them on the standardized admission order sets we develop for CPOE! Of course, we write the order to promote sleep – mainly our own sleep, so we don’t get that phone call that wakes us up just to order a sleep med for a patient!
But now some Pennsylvania hospitals have taken the bold step of literally banning sleep meds for inpatients in an attempt to reduce falls and other adverse events. Doylestown Hospital on July 1 implemented a policy virtually eliminating the use of sleep medications by inpatients. Doylestown had already implemented a significant noise reduction program in the previous six months. And they try to make the inpatient environment conducive to sleep by lowering the lights, closing doors, allowing masks or earplugs, using more private rooms, and allowing personal stereos to be used. They’ll be collecting outcome data to determine whether the medication ban results in fewer adverse events.
It’ll be an interesting experiment. Both lack of sleep and use of sedating agents may increase the risk of delirium and probably falls as well.
Other hospitals have not gone that far but have often taken steps to minimize use of sleep medications, such as not allowing sleep meds to be taken in close temporal relationship to analgesics or antianxiety agents. Others won’t allow their use after a certain time of night. Still others discourage their use in patients over the age of 65 and then use them in lower doses.
Are there potential unintended consequences? Of course. It is conceivable that patients who had been taking sleep meds chronically could develop withdrawal syndromes or seizures. Doylestown’s policy excludes such patient who have been taking sleep meds regularly at home prior to admission.
The pennies saved on medication expense don’t justify the policy. But what will justify it is a significant reduction in adverse events which should translate into a reduction in length of stay as well. That’s where the significant cost savings will appear.
Time will tell! Stay tuned.
Hospital says goodnight to sleeping pills
By: JO CIAVAGLIA
July 17, 2009