Effect of standardized hypnotic bundles on insomnia during hospitalization and reducing fall rate: A single-center retrospective cohort study

Aim

Although the use of benzodiazepine receptor agonists is a risk factor for falls and fractures, whether benzodiazepine-avoiding hypnotic bundles are beneficial in clinical settings remains unclear.

Methods

A new hospital-wide standardized hypnotic bundle for insomnia, with suvorexant as the first choice, was created for clinical purposes. This single-center retrospective cohort study involved a pre-post design and adult inpatients who had had falls. The primary outcome was the total fall rate in the pre-post groups. Additionally, the level change in the fall-rate trend for each month at standardization of the new hypnotic bundle was analyzed. The numbers of hypnotic-related falls and injuries requiring treatment were evaluated.

Results

There were no differences in baseline characteristics between the two groups, except for patients with COVID-19. Overall, 31 736 patients were included in this study. The total number of falls was 924 (3.42‰) in the pre-standardization group and 837 (3.31‰) in the post-standardization group, with no significant difference. An interrupted time-series analysis of the level change in the fall rate revealed that the gap in trend at standardization was –11%, with no significance. Hypnotic-related falls were 300 (1.11‰) versus 213 (0.84‰), and the injury incidences were 251 (0.93‰) versus 181 (0.71‰) in the pre and post groups, respectively, showing a significant reduction.

Conclusions

The standardization of the new hypnotic bundle for insomnia did not help achieve a significant reduction in total falls. However, our findings suggest that this bundle has the potential to reduce hypnotic-related falls and injuries in inpatients who have had falls. Geriatr Gerontol Int 2024; 24: 1144–1149.