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JAMA Intern Med. 2019 Jul 1;179(7):965-972. doi: 10.1001/jamainternmed.2019.1196.

An Implementation Guide to Promote Sleep and Reduce Sedative-Hypnotic Initiation for Noncritically Ill Inpatients.

Author information

1
Division of General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada.
2
Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada.
3
Centre for Quality and Patient Safety, University of Toronto, Ontario, Canada.
4
Department of Pharmacy, Sinai Health System, Toronto, Ontario, Canada.
5
Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada.
6
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
7
Lown Institute, Brookline, Massachusetts.
8
Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
9
Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
10
Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
11
Postgraduate Medical Education, University of Toronto, Toronto, Ontario, Canada.
12
Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, Minnesota.

Abstract

Sedative-hypnotic medications are frequently prescribed for hospitalized patients with insomnia, but they can result in preventable harm such as delirium, falls, hip fractures, and increased morbidity. Furthermore, sedative-hypnotic initiation while in the hospital carries a risk of chronic use after discharge. Disrupted sleep is a major contributor to sedative-hypnotic use among patients in the hospital and other institutional settings. Numerous multicomponent studies on improving sleep quality in these settings have been described, some demonstrating an associated reduction of sedative-hypnotic prescriptions. This selected review summarizes effective interventions aimed at promoting sleep and reducing inappropriate sedative-hypnotic initiation and proposes an implementation strategy to guide quality improvement teams.

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