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Reducing in-hospital patient falls: Could a commonly used drug be the culprit?

“Patient falls are a significant patient safety issue in hospitals and one that has been quite difficult to tackle, despite considerable efforts. That is why it is one of the target aims of the U.S. Department of Health and Human Services Partnership for Patients project,” says Dr. Timothy I. Morgenthaler, Mayo Clinic’s Chief Patient Safety Officer, who specializes in sleep disorders and pulmonary and critical care.

With this in mind, sleep specialists from the Mayo Clinic set out to study the effects of a drug commonly prescribed and administered in hospital settings to help patients sleep, but which has been associated with an increased risk of falls.

The recently published study included 4,962 patients who were prescribed zolpidem during their hospital stay. What they found was that the fall rate among these patients was four times as high as those patients who were recorded to have not been prescribed zolpidem (11,358 patients).

“Discovering that zolpidem, which is commonly used in hospitals, is a significant risk factor for patient falls provides us with additional knowledge to help tackle this problem,” says Dr. Morgenthaler.

The sleep specialists also found that the risk posed by the drug was greater than the risks posed by factors such as age, cognitive impairment, delirium or insomnia, regardless of the dosage used.

Key findings of the study include:

  • Approximately 39% of eligible patient admissions during 2010 were prescribed zolpidem (16,320 patients), but 88% of the prescriptions were issued on an “as-needed basis.”
  • Zolpidem was administered to 30.4% of patients who were prescribed it and to 11.8% of all Mayo Clinic admissions in 2010.
  • Just over 3% of the patients on zolpidem fell during their in-patient hospital stay, compared with 0.7% of the patients who did not take zolpidem.
  • Zolipdem use continued to be associated with an increased fall risk when other key factors, including health, length of hospital stay and assessed fall risk, were taken into consideration.
“Our hospitals have an overall fall rate of about 2.5 per 1000 patient days, which is lower than many national benchmarks. However, we have not been able to significantly reduce this rate in recent years. Now, we calculate that for every 55 patients who received zolpidem, there was one additional fall that may have been avoided by not administering the drug,” says Dr. Morgenthaler. “As a result of our study, we are now phasing out zolpidem and moving toward sleep enhancement techniques that are not based on drugs and which we believe are safer and probably as effective.”