The use of an electronic clinical rule to discontinue chronicallyused benzodiazepines and related Z drugs

AbstractPurpose The chronic use of benzodiazepines andbenzodiazepine-related drugs (BZ/Z) in older people is commonand not without risks. The objective of this study was toevaluatewhether the implementationof a clinical rule promotesthe discontinuation of chronically used BZ/Z for insomnia.Methods A clinical rule, generating an alert in case of chronicBZ/Z use, was created and applied to the nursing home (NH)setting. The clinical rule was a one-off intervention, and alertsdid not occur over time. Reports of the generated alerts weredigitally sent to NH physicians with the advice to phase outand eventually stop the BZ/Z. In cases where the advice wasadopted, a follow-up period of 4 months on the use of BZ/Zwas taken into account in order to determine whether the clinicalrule alert led to a successful discontinuation of BZ/Z.Results In all, 808NHpatientswere screened. In 161 (19.1%)ofthe patients, BZ/Z use resulted in a clinical rule alert. From these,the advice to phase out and stop the BZ/Z was adopted for 27patients (16.8%).Reasons for not following the advice consistedof an unsuccessful attempt in the past (38 patients), patients familyand/or patient resistance (37 patients), the non-continuous useof BZ/Z(32 patients) and indication still present (27 patients).Ofthe 12 NH physicians, seven adopted the advice.Conclusions The success rate of a clinical rule for discontinuationof chronically usedBZ/Z for insomnia was low, as reportedin the present study. Actions should be taken to help caregivers,patients and familymembers understand the importanceof limiting BZ/Z use to achieve higher discontinuation rates.Keywords Benzodiazepines . Nursing home patients .Clinical rule . Discontinuatio