BackgroundMany elderly patients receive psychotropic drugs. Treatment with psychotropic agents is associated with serious side effects including an increased risk of falls and fractures. Several psychotropic drugs are considered potentially inappropriate for treatment of the elderly.MethodsA retrospective chart review was conducted covering all patients aged ≥ 65 years who were admitted to Evangelisches Krankenhaus Göttingen-Weende between 01/01/2013 and 03/31/2013. Psychotropic drugs reviewed for included benzodiazepines, Z-drugs, antidepressants and neuroleptics, but not drugs for sedation during artificial ventilation or pre-medication before surgery. Potentially inappropriate drugs were identified according to the PRISCUS list. To assess which factors were associated with the administration of psychotropic drugs, univariate and multivariable logistic regression analyses were performed.ResultsThe charts of 2130 patients (1231 women) were analyzed. 53.9% of all patients received at least one psychotropic medication (29.5% benzodiazepines, 12.6% Z-drugs, 22.2% antidepressants, 11.9% neuroleptics). The mean number of psychotropic drugs prescribed per patient with at least one prescription was 1.6. Patients treated in the geriatric department most often received antidepressants (45.0%), neuroleptics (20.6%) and Z-drugs (27.5%). Benzodiazepines and Z-drugs were prescribed mostly as medication on demand (77.7% of benzodiazepines, 73.9% of Z-drugs). Surgical patients most frequently received benzodiazepines (37.1%). Nearly one-third of all patients ≥ 65 years was treated with at least one potentially inappropriate psychotropic medication. The mean number of potentially inappropriate psychotropic medications per patient with at least one psychotropic prescription was 0.69. The percentage of patients with potentially inappropriate psychotropic medication was highest in the surgical departments (74.1%). Female gender (adjusted OR 1.36; 95% CI 1.14 to 1.63), stay in the Department of Geriatrics (2.69; 2.01 to 3.60) or the interdisciplinary intensive care unit (1.87; 1.33 to 2.64) and age ≥ 85 years (1.33; 1.10 to 1.60) were associated with psychotropic drug treatment.ConclusionsA high percentage of patients aged ≥ 65 years received psychotropic drugs. The chance that a potentially inappropriate psychotropic drug would be administered was highest in the surgical departments. Antidepressants, neuroleptics and Z-drugs were used surprisingly often in geriatric medicine. Educational strategies could reduce the use of psychotropic drugs and the prescription of potentially inappropriate medications.

IntroductionHypnotics and sedatives, especially benzodiazepines and Z-drugs, are frequently prescribed for longer periods than recommended—in spite of potential risks for patients. Any intervention to improve this situation has to take into account the interplay between different actors, interests and needs. The ultimate goal of this study is to develop—together with the professionals involved—ideas for reducing the use of hypnotics and sedatives and then to implement and evaluate adequate interventions in the hospital and at the primary and secondary care interface.Methods and analysisThe study will take place in a regional hospital in northern Germany and in some general practices in this region. We will collect data from doctors, nurses, patients and a major social health insurer to define the problem from multiple perspectives. These data will be explored and discussed with relevant stakeholders to develop interventions. The interventions will be implemented and, in a final step, evaluated. Both quantitative and qualitative data, including surveys, interviews, chart reviews and secondary analysis of social health insurance data, will be collected to obtain a full understanding of the frequency and the reasons for using hypnotics and sedatives.Ethics and disseminationApproval has been granted from the ethics review committee of the University Medical Center Göttingen, Germany. Results will be disseminated to researchers, clinicians and policy makers in peer-reviewed journal articles and conference publications. One or more dissemination events will be held locally during continuous professional development events for local professionals, including (but not confined to) the study participants.

Even if doctors try to act rationally, they cannot escape the interplay of contextual factors such as handling patient needs, complying with administrative regulations, and managing time resources. Doctors should balance these factors as if they were challenges in a complex game and reflect upon their own practices.

Bedsores can usually be avoided by adequate care and preventive measures. In the context of the local agenda process a local district office (Landratsamt) and inspection units initiated a variety of activities to promote sensitisation in health institutions and contribute to an increase in life quality of the persons concerned. Nearly all nursing care homes, domiciliary services and hospitals participated in a pilot study which was accompanied by the Fraunhofer IAO in Stuttgart. Objectives of the pilot study were to implement internal quality assurance to sensitise for persons the topic and to collect comparable data to achieve benchmarking. Software-tool institutions recorded data on care days, days spent with bedsores according to care level from July till September 01. Major result was that - although institutions had already a decreasing incidence in bedsores since the start of discussing the project - bedsore quotas could be further decreased from 2.15 to 1.84 %.

Zusammenfassung. Hintergrund: Ältere Patienten leiden im Krankenhaus häufig unter Ein- und Durchschlafproblemen. Nicht selten erhalten diese Patienten trotz der bekannten Risiken ein Schlaf- oder Beruhigungsmittel, obwohl auch nicht-medikamentöse Maßnahmen zur Verfügung stehen. Ziel: Die Studie untersucht Erfahrungen und Wahrnehmungen von Pflegenden im Umgang mit nicht-medikamentösen Maßnahmen bei Schlafproblemen älterer Patienten im Krankenhaus. Methode: Es wurden semistrukturierte Interviews mit 13 examinierten Gesundheits- und Krankenpflegern / -pflegerinnen aus einem Krankenhaus geführt und inhaltsanalytisch ausgewertet. Ergebnisse: Folgende nicht-medikamentöse Maßnahmen werden bei Schlafproblemen älterer Patienten eingesetzt: (1) strukturelle Maßnahmen (Regulierung von Temperatur und Licht), (2) organisatorische Maßnahmen (Zeit für abendliche Rundgänge), (3) pflegerische Maßnahmen (pflegerische Schlafanamnesen, beruhigende Ganzkörperpflegen) und (4) übliche Hausmittel. Die Anwendung dieser Maßnahmen erhöht die Patientenzufriedenheit und entspannt Abläufe im Nachtdienst. Barrieren ergeben sich durch knappe zeitliche und personelle Ressourcen, fehlende Standards, diskrepante Vorstellungen im Pflegeteam und dezidierte Patientenwünsche nach Medikamenten. Schlussfolgerung: Pflegende kennen eine Vielzahl nicht-medikamentöser Maßnahmen zur Förderung eines gesunden Schlafes. Das Fehlen eines Konsenses und mangelnde Ressourcen behindern den Einsatz dieser Maßnahmen. Wünschenswert wäre ein Klima, das den Einsatz von Medikamenten bei Schlafproblemen als letzte Möglichkeit vorsieht.

Aim | Benzodiazepines and Z-drugs are frequently prescribed sleep medications in spite of their poor risk-benefit ratio when used over a longer period of time. The aim of the study was to find out how the medical and nursing staff in a general hospital estimated the frequency of use for these drugs, and the risk-benefit ratio for elderly patients as well as the factors which positively influence the perceived use of these drugs. Methods | All members of the medical and nursing staff of a hospital received a questionnaire about their use of, and attitudes towards, benzodiazepines and Z-drugs. Absolute and relative frequencies were calculated to estimate the perceived frequency of use and the risk-benefit ratio. Multiple logistic regressions were used to analyze which factors are associated with a perceived high use of benzodiazepines or Z-drugs for insomnia. Results | More nurses than hospital doctors believed that they dispensed benzodiazepines often or always (57 % vs. 29 %) to patients with insomnia; this was also the case for Z-drugs (66 % vs. 29 %). Nearly half of the hospital doctors and 29 % of the nurses perceived more harms than benefits for benzodiazepines in the elderly. The following factors were associated with a high perceived usage of Z-drugs: working as a nurse (OR: 13,95; 95%-CI: 3,87-50,28), working in a non-surgical department (5,41; 2,00-14,61), having < 5 years of professional experience (4,90; 1,43-16,81) and feeling that the benefits of Z-drugs outweigh the risks for elderly patients (5,07; 1,48-17,35). For benzodiazepines, only the perceived positive risk-benefit ratio had an influence on the perceived use (3,35; 1,28-8.79). Conclusion | The medical and nursing staff perceived the frequency of prescription of benzodiazepines and Z-drugs and the risk-benefit ratio in different ways. Other aspects, such as working in a non-surgical department or having a smaller amount of working experience may also influence the decision to use Z-drugs.

No abstract

No abstract