November 28, 2012
Patients Using Sleep Medication Have Much Greater Risk for Hospital Falls

Rochester, MN—Hospital patients had a four times greater risk of falling if they were using a commonly prescribed sleep medication, according to a new study.

In a study published in the Journal of Hospital Medicine, Mayo Clinic researchers reported that the fall rate among the 4,962 patients who took zolpidem during their hospital stay was more than four times as high as the 11,358 who did not take the drug.

Zolpidem is marketed as Ambien, Ambien CR, Edluar, Intermezzo, and Zolpimist, and can be administered as a regular tablet, an extended-release tablet, a sublingual tablet, or an oral spray, according to the National Institutes of Health (NIH).

Regardless of the dosage used, that fall risk was greater than other important factors such as age, cognitive impairment, delirium, or insomnia. As a result, Mayo Clinic officials said they are trying to phase out use of zolpidem and experimenting with nondrug sleep-enhancement techniques.

“Ensuring that people get enough sleep during their hospital stay is very important, but it can also prove very challenging,” said Timothy I. Morgenthaler, MD, Mayo Clinic’s chief patient safety officer.

Morgenthaler noted that patient falls are a troublesome patient safety issue and that “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.”

The report noted that nearly 39% of eligible patients were prescribed zolpidem at the Mayo Clinic, although 88% of the prescriptions were issued on an as-needed basis. The compound was administered to about 30% of patients prescribed it, representing 11.8% of all clinic admissions in 2010.

Of the patients on zolpidem, slightly more than 3% fell during their inpatient hospital stay. The rate for patients who did not take the drug was 0.7%.

The higher rate of falls with zolpidem use held up despite patients’ health status, length of stay, and assessed fall risks.

"Our hospitals have an overall fall rate of about 2.5 per 1,000 patient days, which is lower than many national benchmarks. However, we have not been able to significantly reduce this rate in recent years,” Morgenthaler noted. “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.”

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