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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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Accepted for Publication: March 14, 2019.
Corresponding Author: Christine Soong, MD, MSc, Division of General Internal Medicine, Mount Sinai Hospital, 433-600 University Ave, Toronto, Ontario M5G 1X5, Canada (firstname.lastname@example.org).
Published Online: June 3, 2019. doi:10.1001/jamainternmed.2019.1196
Author Contributions: Dr Soong had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Soong, Burry, Cho, Gathecha, Kisuule, Tannenbaum, Morgenthaler.
Acquisition, analysis, or interpretation of data: Soong, Burry, Cho, Gathecha, Tannenbaum, Vijenthira, Morgenthaler.
Drafting of the manuscript: Soong, Burry, Morgenthaler.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Soong.
Administrative, technical, or material support: Soong.
Supervision: Soong, Tannenbaum.
Conflict of Interest Disclosures: None reported.
Additional Contributions: Pamela Johnson, MD, Department of Radiology, Johns Hopkins University, and Justin Turner, PhD, Faculty of Pharmacy, Université de Montréal, provided review and helpful suggestions in the development of this guide. They were not compensated for their contributions.
Additional Information: Drs Soong, Burry, Cho, Gathecha, Kisuule, Vijenthira, and Morgenthaler are members of the High Value Practice Academic Alliance. The High Value Practice Academic Alliance is a consortium of academic medical centers in the United States and Canada working to advance high-value health care through collaborative quality improvement, research and education. For additional information, visit http://www.hvpaa.org.
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