Abstract
We reviewed the charts of 476 patients admitted to a university teaching hospital to determine whether sedative-hypnotic drugs (SHDs) were being used excessively and to examine the use of SHDs as hypnotics. The frequency of medical and surgical indications for barbiturates and benzodiazepines or other minor tranquillizers as well as the use of such drugs were compared among different groups of patients and specialty wards. Of the patients 29% had a regular order and 40% had a PRN order; only 77% of the PRN orders were administered. A total of 215 patients (45%) received an SHD during their hospital stay, and 160 (34%) received the drug as a hypnotic. Medical indications accounted for 49% of the regular orders but only 2% of the PRN orders; moreover, 89% of all the PRN orders were for insomnia. On average, patients receiving SHDs as hypnotics were older (p less than 0.05) and stayed longer in hospital (p less than 0.01) than those who did not; however, no patient on the geriatric or pediatric ward received an SHD as a hypnotic during the hospital stay. The differences in use between patient groups may have been influenced by orientation of ward staff. Physicians should review their rationale for prescribing hypnotics and avoid routine orders on admission.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Balter M. B., Manheimer D. I., Mellinger G. D., Uhlenhuth E. H. A cross-national comparison of anti-anxiety/sedative drug use. Curr Med Res Opin. 1984;8 (Suppl 4):5–20. doi: 10.1185/03007998409109541. [DOI] [PubMed] [Google Scholar]
- Bayer A. J., Pathy M. S. Requests for hypnotic drugs and placebo response in elderly hospital in-patients. Postgrad Med J. 1985 Apr;61(714):317–320. doi: 10.1136/pgmj.61.714.317. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bergman U., Christenson I., Jansson B., Wiholm B. E. Auditing hospital drug utilisation by means of defined daily doses per bed-day. A methodological study. Eur J Clin Pharmacol. 1980;17(3):183–187. doi: 10.1007/BF00561898. [DOI] [PubMed] [Google Scholar]
- Boethius G., Westerholm B. Purchases of hypnotics, sedatives and minor tranquillizers among 2,566 individuals in the county of Jämtland, Sweden. A 6-year follow-up. Acta Psychiatr Scand. 1977 Aug;56(2):147–159. doi: 10.1111/j.1600-0447.1977.tb06673.x. [DOI] [PubMed] [Google Scholar]
- Brooks-Hill R. W., Buckingham R. A. Evaluating the effectiveness of a process medical audit in a teaching general hospital. CMAJ. 1986 Feb 15;134(4):350–352. [PMC free article] [PubMed] [Google Scholar]
- Corrigan O. I. Drug prescribing in an orthopaedic hospital with particular reference to night sedative consumption. Ir Med J. 1983 Jan;76(1):21–24. [PubMed] [Google Scholar]
- Gerard P., Collins K. J., Dore C., Exton-Smith A. N. Subjective characteristics of sleep in the elderly. Age Ageing. 1978;Suppl:55–63. doi: 10.1093/ageing/7.suppl.55. [DOI] [PubMed] [Google Scholar]
- Hendriksen C., Lund E., Strømgård E. Intake of drugs among elderly people in a Danish municipality, Rødovre. Acta Med Scand. 1983;214(1):67–71. doi: 10.1111/j.0954-6820.1983.tb08572.x. [DOI] [PubMed] [Google Scholar]
- Johnson J., Clift A. D. Dependence on hypnotic drugs in general practice. Br Med J. 1968 Dec 7;4(5631):613–617. doi: 10.1136/bmj.4.5631.613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kesson C. M., Gray J. M., Lawson D. H. Benzodiazepine drugs in general medical patients. Br Med J. 1976 Mar 20;1(6011):680–682. doi: 10.1136/bmj.1.6011.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lawson D. H., Jick H. Drug prescribing in hospitals: an international comparison. Am J Public Health. 1976 Jul;66(7):644–648. doi: 10.2105/ajph.66.7.644. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mellinger G. D., Balter M. B., Uhlenhuth E. H. Anti-anxiety agents: duration of use and characteristics of users in the U.S.A. Curr Med Res Opin. 1984;8 (Suppl 4):21–36. doi: 10.1185/03007998409109542. [DOI] [PubMed] [Google Scholar]
- Miller R. R. Drug surveillance utilizing epidemiologic methods. A report from the Boston Collaborative Drug Surveillance Program. Am J Hosp Pharm. 1973 Jul;30(7):584–592. [PubMed] [Google Scholar]
- Morrison D., Mayfield D. G. Sleep insurance: a valid use of hypnotics? N C Med J. 1972 Oct;33(10):862–865. [PubMed] [Google Scholar]
- Mulligan A. F., O'Grady C. P. Reducing night sedation in psychogeriatric wards. Nurs Times. 1971 Sep 2;67(35):1089–1091. [PubMed] [Google Scholar]
- Perry S. W., Wu A. Rationale for the use of hypnotic agents in a general hospital. Ann Intern Med. 1984 Mar;100(3):441–446. doi: 10.7326/0003-4819-100-3-441. [DOI] [PubMed] [Google Scholar]
- Prien R. F., Balter M. B., Caffey E. M., Jr Hospital surveys of prescribing practices with psychotherapeutic drugs. A critical examination. Arch Gen Psychiatry. 1978 Oct;35(10):1271–1275. doi: 10.1001/archpsyc.1978.01770340115014. [DOI] [PubMed] [Google Scholar]
- Salzman C. Psychotropic drug use and polypharmacy in a general hospital. Gen Hosp Psychiatry. 1981 Mar;3(1):1–9. doi: 10.1016/0163-8343(81)90016-5. [DOI] [PubMed] [Google Scholar]
- Shapiro S., Slone D., Lewis G. P., Jick H. Clinical effects of hypnotics. II. An epidemiologic study. JAMA. 1969 Sep 29;209(13):2016–2020. [PubMed] [Google Scholar]
- Siciliani O., Bellantuono C., Williams P., Tansella M. Self-reported use of psychotropic drugs and alcohol abuse in South-Verona. Psychol Med. 1985 Nov;15(4):821–826. doi: 10.1017/s0033291700005055. [DOI] [PubMed] [Google Scholar]
- Winstead D. K., Blackwell B., Eilers M. K., Anderson A. Psychotropic drug use in five city hospitals. Dis Nerv Syst. 1976 Sep;37(9):504–509. [PubMed] [Google Scholar]