Awareness-raising Activities for the Appropriate Use of Prescribed Medication for Insomnia to Reduce the Risk of Delirium
Background: The number of dementia patients is rapidly increasing in Japan, having reached approximately 4.43 million in 2022, with predictions suggesting it will rise to approximately 5.84 million by 2040. The onset of delirium in dementia patients adversely affects in-hospital prognosis and increases the consumption of medical resources. A dementia delirium care team (OP-CAST) has been established at our facility to provide appropriate care for dementia patients. Given the importance of selecting medication for insomnia, our team conducts awareness-raising activities for the medical staff. As part of this initiative, we published the“ OP-CAST Newsletter” to provide information on the prevention of insomnia and delirium, with a particular focus on the selection of recommended medications for insomnia. Herein, we investigated changes in the prescribed medications for insomnia before and after the publication of this OP-CAST Newsletter. Methods: The survey was conducted in two phases: three months immediately before the publication of the first issue of the OP-CAST Newsletter in January 2020 (October to December 2019, Phase 1) and three months during which the survey was conducted (January to March 2023, Phase 2). We reviewed the medical records and retrospectively investigated the medications prescribed for insomnia in patients who were hospitalized during these periods. Results: The results indicated that the usage ratio of recommended medication (orexin receptor antagonists) increased from 49% to 91%, while the usage ratio of benzodiazepines (BZDs; zopiclone, zolpidem, etc.) decreased from 44% to 3%. These changes were statistically significant, confirming a marked increase in the usage of recommended medication. Discussion: Awareness-raising activities regarding recommended medications for the treatment of insomnia, as disseminated through the OP-CAST Newsletter, have significantly increased medical staff members’ awareness of medication selection and promoted the use of appropriate medication. In particular, orexin receptor antagonists have been shown to reduce the risk of delirium and falls more effectively than benzodiazepines (BZDs) and are therefore expected to improve patient prognosis. The OP-CAST Newsletter is visually accessible, and the results suggest that it serves as an effective awareness-raising tool that successfully engages staff interest. Conclusions: Awareness-raising activities utilizing the OP-CAST Newsletter promoted the appropriate use of prescribed medication for insomnia and successfully reduced the utilization of BZDs. This is expected to decrease the risk of delirium and falls, thereby confirming the efficacy of the newsletter as an awareness-raising tool in medical settings.
