Melatonin Swapped for Benzodiazepines Postoperatively in Older Adults

First-line use of benzodiazepines and sedative-hypnotic agents postoperatively for sleep in older adults is related to prolonged hospital stays and increased risk of falls and delirium. An intervention to swap melatonin for these agents in this population lead to a 33% decreased use of benzodiazepines and sedative-hypnotic agents, Amaka Opute, DNP, APRN, ACNP-BC, explained in a poster session at the DNPs of Color 2022 Annual Conference held October 21 to 23, 2022, in Baltimore, MD.

“Other health care organizations could easily implement similar educational interventions monthly, quarterly, or semi-annually with the goal of changing prescribing practices amongst health care providers,” Amaka Opute, DNP, APRN, ACNP-BC, said in an interview.

This quality improvement project was designed to decrease prescribing of benzodiazepines and sedative-hypnotic medications as first-line agents for sleep postoperatively by 5% within 90 days of project initiation and increase prescribing of melatonin in older adults at The University of Texas Southwestern Medical Center.

The intervention consisted of educational in-services for advanced practice providers, residents, and nursing staff on the adverse effects of benzodiazepine use among older adults and the Choosing Wisely guidelines. Staff members were also educated on first-line use of melatonin for sleep in this population as well as nonpharmacologic strategies to promote sleep. Prescription monitoring led to further education for certain providers when needed.

Prescribing of Benzodiazepines Decreased

Key study findings at 90-days were as follows:

• 33% decrease in prescribing of benzodiazepines and sedative-hypnotic agents

• 12% increase in prescribing of melatonin

• 28% decrease in the number of patient safety sitter hours required (a proxy for patient delirium)

“Provider education and nursing education, coupled with transparent monitoring of prescribing practices, decreased the prescription of benzodiazepines and sedative-hypnotics,” Dr Opute concluded. Dr Opute plans to test the intervention in a different unit for a longer period and with an electronic order set that replaces benzodiazepines with melatonin.

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This article originally appeared on Clinical Advisor