Evaluating the Impact of Pharmacists on Reducing Use of Sedative/Hypnotics for Treatment of Insomnia in Long-Term Care Facility Residents

OBJECTIVE: To determine if pharmacist intervention can decrease the use of inappropriate sedative/hypnotics in the elderly population in the long-term care facility setting.

DESIGN: A multicenter, prospective chart review of sedative/hypnotic use for insomnia among long-term care facility residents.

SETTING: Eleven regional long-term care facilities in Northeastern Tennessee.

PARTICIPANTS: Long-term care facility residents older than 65 years of age, with confirmed insomnia diagnoses and no history of seizure or recent psychotropic gradual-dose reduction attempts.

INTERVENTION: Consultant pharmacist recommendations to decrease inappropriate use of sedative/hypnotics.

MAIN OUTCOME MEASURE: Acceptance rates for discontinuation/tapering of the selected sedative/hypnotics.

RESULTS: A total of 36 patients were enrolled in the study based on inclusion/exclusion criteria. Overall, 39 interventions were performed. Gradual dose reductions/ discontinuation of select sedative/hypnotics were accepted for 19 residents (48.7%). Of the other recommendations, 8 (20.5%) were denied and 12 (30.8%) were left unanswered. Primary reasons for denial included family refusal, satisfactory response to current dose, and requirement of increased dose as a result of worsening insomnia.

CONCLUSIONS: Overall, pharmacist intervention can have a meaningful impact on reducing inappropriate sedative/ hypnotic use in the elderly population through concise, evidence-based recommendations to physicians.