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Special Communication
June 3, 2019

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

Author Affiliations
  • 1Division of General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada
  • 2Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
  • 3Centre for Quality and Patient Safety, University of Toronto, Ontario, Canada
  • 4Department of Pharmacy, Sinai Health System, Toronto, Ontario, Canada
  • 5Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
  • 6Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 7Lown Institute, Brookline, Massachusetts
  • 8Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
  • 9Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
  • 10Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
  • 11Postgraduate Medical Education, University of Toronto, Toronto, Ontario, Canada
  • 12Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Intern Med. 2019;179(7):965-972. doi:10.1001/jamainternmed.2019.1196

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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